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Early Intervention Speech Therapy: Supporting a Child’s Development & Growth

During a child’s first few years, the brain grows so rapidly that 1 million new neural connections are formed each second.

Those who don’t gain certain speech and language skills by the ages we expect them to are considered to have a language delay. Early intervention Speech Therapy services can help.

What is Early Intervention Speech Therapy?

Early Intervention (EI) Speech Therapy refers to Speech Therapy services that are provided from birth to 3 years-old to improve delayed speech and language skills.

Research has shown that EI services, which are typically family-centered, can be highly effective at improving a child’s skills. That’s largely because the brain is more flexible during these early years, making it easier to influence.

An early intervention program can include services that address several different areas of a child’s development. For example, Speech Therapy, Occupational Therapy, Physical Therapy, Audiology, and others.

Specialists from these disciplines evaluate the child to gain a measure of his or her skills within a specific area of development. That might include fine motor skills, play skills, gross motor skills (like crawling or walking), comprehension of language, or expressive language (such as speaking the expected number of words for their age), or kinetic skills . If the child is delayed in any area, he or she can start receiving weekly services to improve those skills.

Families should play a central role in the early intervention process, according to studies . They’re considered to be a child’s most important teachers, and their involvement can lead to more effective and efficient services.

Specifically, a child’s speech delay that is identified and treated early can lead to improved outcomes and affect lifelong learning skills.

Here’s how the need for early intervention is recognized, what to expect during sessions, and the components of EI. We’ll also take a look at some early intervention Speech Therapy goals and activities, as well as the auditory stimulation device Forbrain .

Who Needs Early Intervention Speech Therapy

Early intervention may be indicated if a child has difficulty with any of the following skills :

• Speech & Language Skills (such as talking & listening)
• Social-Emotional Skills (including play skills & interacting with others)
• Physical Development (fine & gross motor skills)
• Cognitive Skills (problem solving and learning skills)
• Adaptive Skills (including self-help skills like dressing and bathing)

Parents should look at the expected developmental milestones for their child’s age. If the child is behind in any area, he or she might benefit from Early Intervention services.

Overall, when a child is developing language skills at a slower rate than what is expected for their age, he or she is considered to have a language delay.

Specific signs that a child has a language delay and should receive Early Intervention Speech Therapy are:

• Delayed vocabulary (not saying as many words as they should. For example: saying less than 50 words at age 2 years)
• Trouble understanding what other people say (such as following directions)
• Decreased social interaction (difficulty playing or interacting with other kids (by age 2 to 3 years old)
• Speech is hard to understand (trouble pronouncing simple, early developing sounds like b, p, m, w, h by age 2 and also g, k, t, d, f, n by age 3.
• Stuttering (repeating the first sounds in a word or the whole word several times, tensing their body or getting frustrated when trying to get words out)

A Speech-Language Pathologist (also known as “SLP” or Speech Therapist) can also provide early intervention to improve a child’s feeding skills. This might be indicated if the child is eating a limited variety of foods (picky eating), having behaviors that interfere with eating enough food at mealtime to receive adequate nutrition, or is showing signs of dysphagia, difficulties chewing or swallowing.

The need for early intervention services might be recognized by a child’s pediatrician, daycare/preschool teacher, or parent.

By staying tuned-in to how your child is meeting the expected milestones, you can help identify the need for speech early intervention services that can help him or her develop these important skills.

You can request your child’s pediatrician to write a referral for your local Early Intervention program. This evaluation will most likely be multidisciplinary, meaning your child may be evaluated by several specialists who will look at a variety of skills.

If delays in speech development are found, your child would likely be referred for a comprehensive evaluation by a Speech Therapist.

What to Expect in Early Intervention Sessions

Early Intervention Speech Therapy usually consists of weekly sessions that take place in the child’s home, daycare, or in a clinic.

Sessions address speech and language goals for the child that are set by the Speech Therapist. Families can stay engaged in therapy by providing input about goals.

Early intervention speech therapy goals for a child with a speech and language delay might include:

• Increasing expressive vocabulary (saying more words)
• Articulating certain sounds more accurately
• Following simple directions
• Understanding age-appropriate concepts (i.e., pointing to pictures in a book that someone asks them to, knowing the names of body parts)
• Putting words together to say short phrases (such as “ball please” rather than just, “ball”)

The Speech Therapist (SLP) builds a rapport with the child during the first few sessions. Through play, the child becomes more comfortable and forms a positive relationship with the therapist.

Goals are targeted through fun, age-appropriate activities that keep the child motivated, including:

• Games and toys
• Outdoor play

Examples of activities are:

• The SLP gives the child a choice of which color block he or she wants. Replacing yes or no questions with choices is a strategy for increasing vocabulary.
• The child practices imitating two-word phrases that the SLP says. For example, “go car” or “my turn”.

Families should actively participate in therapy sessions by playing along with the child and SLP. This can help you understand how to use specific therapy techniques. Then you can use the strategies at home with your child to promote their speech development.

Journey Through Early Intervention

Let’s explore the essential steps and strategies involved in providing effective support for children in their early developmental stages.

Step 1: Initial Meeting with the Service Coordinator

After getting in touch with your local Early Intervention program, you’ll be contacted or have an initial meeting with a Service Coordinator.

The Service Coordinator is your central point of contact. He or she will provide you with helpful information about services and resources available and discuss your concerns.

You’ll be asked to provide information about your areas of concern regarding your child’s development. Writing down personal notes or asking for input from others who interact with the child (such as family members or daycare teachers) can help the early intervention team identify potential areas of delays.

Your child will be scheduled for an initial, comprehensive evaluation.

Step 2: Eligibility Determination

During an evaluation, a team of specialists will ask you questions and interact with your child to assess various areas of development, including communication, motor skills, social skills, hearing and vision.

The team may administer a standardized assessment that is play-based and involves requesting your child to do things such as stack blocks, follow directions with toys, and perform other tasks.

The results of the evaluation will show whether your child is delayed, what areas he or she is behind in, and to what level of severity. If he or she meets the requirements for eligibility, your child can receive ongoing early intervention services.

Step 3: Development of an Individualized Family Service Plan (IFSP)

The early intervention team will collaborate to create an Individualized Family Service Plan (IFSP). The plan will outline which services are recommended for your child (such as Speech Therapy, Occupational Therapy, or Physical Therapy), and at what frequency.

The team will work with you to develop goals to improve the areas of development your child is delayed in. Services must begin within 30 days of the IFSP being developed.

Your service coordinator will check in at regular intervals to see how your child’s services are going. The IFSP will also be reviewed periodically, which will include an update of your child’s progress and addition of new goals as needed.

Step 4: Cultural Considerations

The therapists providing services and the rest of the Early Intervention team should make special cultural considerations while working with families. Any cultural preferences should be discussed with the family.

If the is exposed to languages other than English, services may be provided by a bilingual therapist, or with the use of interpretation. This can ensure the child is receiving therapy in their dominant language and that his or her family can participate.

Components of Early Intervention

The components of early intervention encompass a range of crucial elements that work together to provide comprehensive support and assistance to young children with developmental delays or disabilities. Here are the main ones.

Cognitive Skills

Cognitive skills are the skills an individual’s brain uses to complete various tasks. This includes organization, planning, reasoning, learning, and problem-solving. The development of these skills is assessed and may be treated as part of an early intervention program.

Communication Skills

Communication skills include receptive (listening and understanding) and expressive language skills. These are skills that individuals use to communicate wants, needs, and thoughts through gestures and talking. Communication skills are a critical component to later academic skills.

Physical and Sensory Skills

Physical skills can be broken down into fine motor skills (movements made by small muscle groups like fingers) and gross motor skills (movements of larger muscles such as crawling, walking and climbing). These skills help a child move functionally around their environment and explore the world around them.

Vision and hearing abilities should be assessed as part of an Early Intervention program to ensure a child has functional skills in these areas.

An individual’s body takes in information from different senses (such as touch, movement, and seeing), and processes them appropriately. Children who have difficulties with this may have a sensory processing disorder.

Social-Emotional Skills

Play skills are the building blocks of developing several other skills. It’s important for children to learn how to understand and process emotions appropriately, and socially interact with others.

Adaptive or Self-Help Skills

These include everyday activities such as eating, bathing, dressing, and other self-care abilities. A child who has trouble using utensils or getting dressed, depending on their age, could be considered delayed in this area.

Recommended Early Intervention Activities for Speech

Parents play a key role in the early intervention process, and can help their child make more progress towards improving their developmental skills, such as speech and language. Here are some suggested activities to practice during at home:

Singing songs

Sing age-appropriate songs like The Itsy Bitsy Spider. Use the accompanying gestures and encourage your child to imitate them. Once the song is familiar to your child, pause during the song and look expectantly at your child, waiting for him or her to fill in the blank with a word from the song.

Sensory Play

Make an at-home sensory bin by filling a small container with uncooked rice or beans. Hide different objects or toys inside. Encourage your child to feel around and then name the items he or she finds. Give your child simple directions to follow, like “take out” or “put in” different objects.

Model simple words over and over, such as on, off, in, out as you and your child play with bath toys. Ask your child to point to body parts you name before washing them. Use descriptive words like wet and dry to expand your child’s vocabulary.

Outdoor Play

Take turns saying short phrases to describe what you see while on a walk. For example, “I see birds.” Children are expected to use 3 word phrases like this at age 3.

Give your child just small amount of their snack. Encourage him or her to sign or say “more”, and then give more of the snack.

Book Reading

Ask your child to point out different pictures that you name. Hold the book by your face so your child can watch your mouth to see how you pronounce certain sounds.

Benefits of Forbrain in Early Intervention Speech Therapy

Forbrain can be incorporated into early intervention programs by training the brain to process sensory information more effectively.

Forbrain is a research-backed device that analyzes and enhances your voice, amplifying frequencies and rhythm through a dynamic filter. The headphones transmit the sounds back to you.

Professionals like Speech Therapists can use Forbrain can accelerate speech and language development, improve articulation, enhance auditory processing, and boost overall communication skills.

Parents can continue working on improving their child’s speech and language skills by using ForBrain at home.

Final Words

Early Intervention is critical to a child’s development if he or she is delayed in speech and language development, motor skills, or other areas. Parents and caregivers should keep close watch of their child’s skills and compare them to the expected milestones to see if they are on track. Families should seek help promptly if they have concerns about their child’s development. The first few years of a child’s life are incredibly important, and early intervention services can be effective at creating a positive, lasting impact on a child’s future growth and well-being.

Badawieh, M., Al-Shamsi, A., (2023) . The factors that impact the Speech delay in the first three years of a child’s life, Journal of Language and Linguistic Studies, 19 (1), 13-20; 2023.

Mary Pat Moeller; Early Intervention and Language Development in Children Who Are Deaf and Hard of Hearing.  Pediatrics  September 2000; 106 (3): e43. 10.1542/peds.106.3.e43

Pia R Britto, Stephen J Lye, Kerrie Proulx, Aisha K Yousafzai, Stephen G Matthews, Tyler Vaivada, Rafael Perez-Escamilla, Nirmala Rao, Patrick Ip, Lia C H Fernald, Harriet MacMillan, Mark Hanson, Theodore D Wachs, Haogen Yao, Hirokazu Yoshikawa, Adrian Cerezo, James F Leckman, Zulfiqar A Bhutta, Nurturing care: promoting early childhood development, The Lancet, Volume 389, Issue 10064, 2017; Pages 91-102, ISSN 0140-6736

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Guide to early intervention for children’s speech therapy.

Effective communication is essential for everyone. Speech plays a vital role in every child’s formative years, allowing them to express themselves. Speech-related issues can prohibit children from effective communication, often creating frustrating experiences that can be stressful or painful.

Speech intervention can address these concerns and make a significant difference for your child. Identifying and addressing speech-related issues as early as possible can ensure your family can access the tools and resources you need to support your child.

Identifying and Addressing Speech-Related Challenges

During the first few years of your child’s life, it can be challenging to determine when a speech-related issue exists. For example, proud parents often enjoy the baby talk of their toddler, but if the child still mispronounces the same words a few years later, there may be a speech-related issue under the surface. Some warning signs you can  look for in your child  include:

• Number of words:  Around the 18-month point and beyond, your child should be using more than 20 words. At age 2, your child should be using more than 50 words. If your kid only uses the same words, you may want to consider speech therapy.
• Understanding:  Many children understand a few hundred words at age 2. Pay attention to determine if your child comprehends simple phrases and sentences.
• Number of sounds:  Some children with speech-related issues will use the same sounds to say each word. Although this can sometimes come across as endearing baby talk, it’s important to recognize when your child may be struggling.
• Social interactions:  If your child doesn’t talk much around other people, it may be because they lack the ability to communicate effectively.
• Immature speech patterns:  By the second year, your child should be able to combine different words and speak clearly. Monitor immature patterns to determine whether your child needs additional support.

There are many types of speech-related issues and  several common speech disorders  that could affect your child. Consider monitoring symptoms for these conditions:

• Preschool language disorders:  Your child may struggle to follow directions, interpret questions or understand gestures like shrugging or nodding.
• Apraxia of Speech (AOS):  AOS disrupts brain and speech functions, preventing children from physically speaking the thoughts they have.
• Lisps:  Children can have a dental, palatal, interdental or lateral lisp. Each can affect the child differently, making it important to look for the right signs.
• Selective mutism:  If your child only speaks in certain situations, they may have anxiety, sensory integration dysfunction or a speech-language disorder. Often, children with this condition are overcome with stillness, avoid eye contact, present as sulky or awkward, and appear uncoordinated or stiff.
• Stuttering:  Although many people experience times when they stutter over a word or phrase, this condition can be a significant challenge if your child experiences it frequently or in particular situations. You may also notice your child blinking excessively or showing tics if they stutter.

This list is by no means exhaustive, and your child could experience other issues or struggle with a combination of challenges. It’s essential to provide the support and help they need as soon as possible so they can communicate their feelings, improve relationships and boost their self-esteem.

Importance of Early Speech Intervention

Children grow at their own rate, but it’s essential to act quickly if you’re  concerned about a development issue . Effective communication skills in kids are necessary for forming healthy relationships with others and themselves. Early intervention can:

• Help your child learn through play:  Children are more likely to let their guard down when they feel they’re playing rather than working or studying. Early intervention can happen in various settings, including the home, where your child can feel comfortable and happy.
• Reduce the need for specialized instruction:  Early intervention can empower your child to achieve age-appropriate milestones, which can  increase academic readiness  and reduce the need for specialized instruction.
• Empower children:  Children are full of potential, and parents and guardians want to see them succeed in the best ways possible. Early intervention can provide the resources and tools your child needs to overcome challenges and prepare them for the road ahead.
• Promote brain development:  People are the most receptive to learning during the first few years of life. Early intervention can enhance your child’s ability to interact with the environment and  promote healthy brain development .

Tips for Early Childhood Language Support

Parental involvement in speech therapy can work wonders for children. There are several speech therapy  techniques you can practice at home  to support your child. From fun games to dedicated learning time, you can help your child improve their language and better express themselves. Check out these speech therapy strategies that can encourage your child to express themselves while refining their skills:

1. Establish Routines

Repetition can be a great tool for promoting children’s speech development. Work with your child to establish a routine they enjoy. You can integrate simple storybooks, songs, rhymes and more into the routine to reinforce repetition.

After establishing these routines, provide opportunities for your child to fill in the blanks wherever possible. For instance, you could start singing the lines of your child’s favorite song but pause at the end of each line. You could say “head, shoulder, knees and __,” allowing your child to fill in the word “toes.”

While working through routines, use pointing, actions and gestures alongside words when possible. For example, shaking your head while saying “no” or using your hand to motion “stop” when you speak the word are excellent examples.

2. Present Choices

Parents and guardians know their children better than anyone else. You can often anticipate what they want or need before they tell you. Although this can save time, it can limit your child’s opportunities for practicing language skills. Choices can feel empowering for children. Encouraging your child to pick between two activities or objects motivates them to respond with language and learn to communicate their desires. This strategy can also prevent frustration if you choose the wrong activity or object.

3. Model Simple Language

Model language your child can imitate. Children often learn by watching other people, especially close family members who they interact with daily. As your child absorbs language, they can start learning how to use independent words and phrases.

You can also use tricks when introducing a new object. Children often focus more on toys and objects than the person holding them. During these times, bring the object to your mouth and repeat the name of it. This can encourage your child to make a stronger connection between what the thing is and how you pronounce its name.

4. Offer Comments Rather Than Questions

Children can become frustrated with an abundance of questions. They may feel pressured to answer or get upset if they can’t communicate the answer they want to convey. Rather than asking many questions, be sure to make comments on what you touch, smell, see and hear. For example, rather than asking, “What is that?” try saying, “Look at the big red truck.”

You can also pair this strategy with parallel talk. When your child observes your actions, go out of your way to comment about what you’re doing. If your child sees you cooking dinner, you can talk about stirring the ingredients, turning on the oven or getting out the plates and utensils.

5. Be Patient

Patience is essential when teaching any new skill. You will need to slow down and practice waiting when you’re interacting with your child. Your little one may need time to process the information you give them, so give them 10 to 15 seconds before continuing the conversation or making a decision.

6. Tell Stories

Stories are an excellent time to expand vocabulary and learn new ideas. Choosing books and stories that reflect your child’s interest can prompt them to engage in dialogue and express their desires. Appropriate actions and voices can immerse them in the story and highlight patterns. Point to the images on the page you’re talking about and encourage your child to lead the way, such as turning the page or focusing on a particular image.

7. Use Visuals

Visuals are an excellent tool for little ones. You can use images to illustrate routines. For example, using a bulletin board, you can depict a morning routine with pictures of a toothbrush, a child making their bed and a delicious breakfast. This helps your child visualize what to do next and can reduce frustration around not understanding a routine. As your child becomes comfortable using images, you can introduce choices, such as choosing what snack they want to eat after lunch, to empower them to make stronger connections and better understand how their day will flow.

Images can also be helpful for learning about family members, friends, pets, and siblings. Photo books and framed pictures can give your child a frame of reference for important individuals, allowing them to become more comfortable with interacting with them.

8. Give Positive Reinforcement

Understanding when to do something is just as important as learning when not to do something. Parents often use negative language to prevent their children from harming themselves, such as touching hot surfaces or putting something small in their mouths. Using positive reinforcement to express when your child does something good can boost their self-esteem and encourage your child to use more language.

9. Let Them Correct Mistakes

Sabotaging your sentences can motivate your child to communicate by letting them correct your mistakes. Purposely giving your child the wrong item or choice encourages them to express their needs or wants by correcting you. For example, if your child asks for a red crayon, you can purposely give them a green one. This prompts your child to communicate that they need something different and navigate how to do so. Keep in mind that you should help your child if they ask for it or express frustration.

10. Repeat Your Strategies

As we mentioned above, repetition is key for children. Along with establishing routines, repetition reinforces speech therapy techniques. Finding the strategies that most benefit your child and encouraging them to strengthen their skills is essential. Avoid trying to make multiple strategies at once to prevent your child from getting confused or overwhelmed.

11. Use Sign Language

Sign language is an excellent way to transition children to verbal language. Many children find it easier to gesture their thoughts, such as “all done,” than it is to speak the words. Teaching the signs for basic words like “more,” “done,” “help,” “stop” and “go” can reduce their frustration and show the ease of communicating their needs.

12. Eliminate Distractions

Any time you want your child to learn, it’s essential to eliminate distractions. Reducing the presence of sounds, people, and objects that can capture your child’s attention can strengthen the quality of the learning session and prompt more thoughtful interactions.

13. Read Often

You can read with your child before they start using words or reading themselves. Reading broadens the imagination and expands vocabulary  while developing comprehension skills . Little kids can turn the book pages and point to colors, animals and objects that draw their attention. Whether you read bedtime stories or dedicate time each day to opening a new book, this simple practice can go a long way to encourage your child to express themselves.

What Is a Speech-Language Pathologist and How Can They Help?

A Speech-Language Pathologist (SPL) can work with children to provide treatment plans to address a variety of speech-related issues. These professionals can diagnose conditions by looking for specific indicators. An SPL assists with nonverbal and verbal language skills, empowering children to communicate more effectively. SPLs focus on repetitive language, speech and expressive language to help children develop new abilities.

During early intervention, an SPL can incorporate play and games as therapies to address issues. Some activities could include sound echoing games, physical therapies to strengthen mouth muscles, or verbalization with pictures, books, and other materials. These therapies can address speech concerns while improving articulation, social skills, and auditory processing.

At Kids SPOT, our SPLs can assess, diagnose, and treat concerns. Our team can help prevent cognitive, language, voice, communication, fluency, speech, and swallowing disorders. Our speech therapy services offer a variety of benefits for children , including improving communication and vocal quality, increasing dependence, boosting self-esteem, and empowering children to keep up with their peers.

Access Speech Therapy Services for Your Child

At Kids SPOT, we understand it can be challenging to find the best services for your child. Kids SPOT offers expert speech, occupational, physical, and occupational therapy to children from birth to age 21. Our team focuses on every child’s overall well-being and creates an atmosphere to promote growth, learning, and exploration. Our personalized and comprehensive approach boosts self-esteem and ensures you can feel confident that your child receives the services they need to reach their full potential.

We have more than 15 years of experience in the industry and continue to pursue our vision of changing children’s lives. Our team provides the tools they need to enhance behavior, health, performance, and confidence to thrive at every stage of development. Our pediatric services evaluate your child’s needs based on their current condition, getting to know their strengths and what they need to work on.

We want to be your partner throughout this journey. You can easily  request an appointment for your child  or  contact us with any questions  you have about our services.

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Speech Therapy for Toddlers

What is speech therapy.

• Language Development
• Signs of Delay
• Speech Therapy Activities
• A Parent's Role

Frequently Asked Questions

Speech therapy is a treatment led by a speech and language pathologist (SLP) or speech therapist. It helps a person communicate and speak more clearly. Toddlers may develop language or speech impairments due to illness, hearing problems, or brain disorders.

This article covers speech and language milestones, causes of speech disorders, diagnosis, what happens in speech therapy, and how parents can help their toddlers. 

Dragana991 / Getty Images

Speech therapy is a treatment that helps a person speak or communicate more effectively. It is performed by specially trained speech and language pathologists (SLPs) or speech therapists. They help their patients better understand others, pronounce words clearly, or put words together. 

There are different types of speech therapy and their use will depend on the age of the child and what they are experiencing. For example, therapy practices vary for children with apraxia (difficulty pronouncing different syllables), stuttering, aphasia (difficulty speaking due to damage to the brain), and difficulty swallowing, and for late talkers.

Language Development (Newborn to Toddler)

While delay does not always mean there’s a problem, it’s important to recognize when a toddler misses a developmental milestone. The following are general guidelines of speech and language development for babies and toddlers:

Newborns communicate through crying. Their cries may sound the same at first but start to vary as they grow. They also cry to express emotions, and parents begin to understand what different cries mean.

High-Pitched Crying

A high-pitched cry not resolved by comforting or eating may mean that an infant is experiencing discomfort or pain.

Newborns pick up on rhythms of speech and their parents' voices within the first few weeks of life. Between 1 and 4 months old, they become more alert to sounds and may startle more easily or turn to look for the source of the noise. 

Around 2 to 3 months old, infants start smiling and cooing, which often sounds like "ah" or "eh." Babies begin laughing by 3 to 4 months old.  

By 5 or 6 months old, infants imitate adult sounds produced by babbling or shrieking. Babbling involves repeating sounds such as "ba," "ma," or "ga."  

7–12 Months

Seven-month-old infants hear words as distinct sounds and try to repeat them. By 9 months old, they start to understand expressions and simple commands like "no," recognize words for objects, and respond to their names.

Ten- to 12-month-olds follow simple commands such as "give mommy your cup." They also begin to say simple words such as "dada" or "bye-bye."

A Toddler's First Words

Most 1-year-olds can say a few words such as “up” or “dog” but do not put words together in a sentence.

13–18 Months

By 18 months, a toddler puts two words together and says phrases such as "push it." They often communicate in gestures that get more complex over time.

Toddlers this age start recognizing objects, body parts, pictures, or people. For example, if you ask, "Where is your nose?," they will be able to point to it.  

19–24 Months

By 24 months old, toddlers know and say 50 or more words. They start to form two- to three-word sentences. Two-year-olds can usually communicate their needs, such as “I want more milk,” and follow two-step commands.

Speech and Language Developmental Timeline

Children develop at different speeds and may not follow the typical timeline. If you are concerned about the delay, contact your pediatrician or healthcare provider as soon as possible. Early treatment can make a difference.

Signs of Speech or Language Delay in Toddlers

The following are general guidelines to help parents know if they should have their young child evaluated for speech or language problems:

• A baby who does not vocalize or respond to sound
• A 1-year-old who does not use gestures, such as pointing
• An 18-month-old who would rather use gestures than sounds
• An 18-month-old who has difficulty imitating sounds or understanding simple requests
• A 2-year-old who imitates speech but doesn’t talk spontaneously
• A 2-year-old who can say words but not communicate more than their immediate needs or follow simple directions
• A 2-year-old who has a raspy or nasal-sounding voice

Understanding the Words of a Toddler

Parents and regular caregivers usually understand about 50% of a toddler’s speech by 2 years old and 75% by 3 years old.

Speech or language delays can occur due to problems with the structures of the mouth, head injuries, chronic illnesses, or brain disorders.  

If the cause is a brain disorder, it can be difficult to coordinate their tongue, lips, and mouth to make sounds or words. 

Hearing problems can make it difficult to imitate or understand language. This is not always a problem that is apparent at birth. Chronic ear infections can cause hearing damage in one or both ears.

A speech therapist will perform tests with your toddler to check the following:

• What your child understands
• What your child can say 
• Clarity of speech
• How the structures in their mouth work together to form words and eat

The following are diagnostic tests or scales a speech therapist may perform with your toddler:

• Bayley Scales of Infant and Toddler Development (Bayley-III) : Bayley-III is used worldwide to measure all aspects of development from birth to 42 months. A speech therapist administers the language portion by watching the child follow instructions and identify people and objects. It helps them know if the child is on track or needs further evaluation. 
• Preschool Language Scales–Fifth Edition (PLS)-5 English : The PLS-5 is an interactive screening tool designed for infants and young children. Speech therapists measure all areas of language through a play-based approach. 
• Differential Ability Scales Assessment–Second Edition (DAS-II) : The DAS-II provides a scale to help speech therapists better understand how a child processes information. This allows them to develop appropriate activities for therapy.
• Goldman-Fristoe Test of Articulation 3 (GFTA-3) : The GFTA-3 involves asking a child to identify colorful drawings and measures their ability to pronounce consonants.
• The Rossetti Infant-Toddler Language Scales: This test is specifically designed for children from birth to 36 months old. It involves a parent interview, as well as observation of the child performing tasks.

What Happens During Speech Therapy?

The speech therapist will plan and perform activities to help your toddler with skills based on their specific needs. Therapy may occur in small groups or individually. 

Language building activities include using picture books, repetition, talking, and playing. If a toddler has difficulty pronouncing certain words, the therapist will teach them how to make the sound or say specific words. 

Sometimes speech therapists help toddlers with speech mechanics. This involves teaching them how to move their mouth or tongue to pronounce a word. They may also prescribe lip, tongue, or jaw exercises to continue at home.

What Concerns are Addressed During Speech Therapy?

Some of the concerns that SLPs may address during speech therapy include:  

• Speech mechanics
• Word pronunciation
• Volume or quality of speech
• Social communication skills
• Trouble swallowing

How Can Parents Help?

It helps to talk and read to your child frequently. Use correct names and speak in a slow and clear voice. When giving direction, keep things simple. Kneeling to their level can them focus on what you are saying.

If your child points at a glass of water, help them connect the gesture and language by asking, “Do you want water?” When they don’t pronounce words accurately, emphasize the correct pronunciation when responding.

Waiting for a Response

When asking a question such as “Do you want a drink?,” try waiting for a response. This helps your toddler learn to communicate back to you. 

Chronic illnesses, brain disorders, and hearing problems can cause a toddler to have delayed speech or language development. Speech therapy can help them learn to communicate more effectively. 

Parents can help by talking to their children often, speaking clearly, and emphasizing correct pronunciation. If your child is in speech therapy, it’s helpful to perform exercises prescribed by your speech therapist at home.

A Word From Verywell

Not all children follow a typical timeline for speech and language development. Sometimes they are focused on learning a new task, such as walking, and put language development on the back burner. They often catch up later. 

If your toddler is experiencing a language or speech delay, talk with your child’s healthcare provider. If there is a problem, getting help early can make a difference.

A toddler should start speech therapy any time after 3 months old if they experience developmental delays in speech or language. This may seem young, but a speech therapist can monitor the signs if there is a delay. Early intervention can make an impact. 

The estimated national average cost for the United States is $218 per session. However, many insurances and most state Medicaid programs cover speech therapy. It can be helpful to find an in-network clinic to decrease your out-of-pocket expenses. 

Nemours Kids Health. Delayed speech or language development . KidsHealth.org.

Durkin MJ. From Infancy to the Elderly: Communication throughout the Ages. Nova Science Publishers; 2011.

Meadows-Oliver M. Pediatric Nursing Made Incredibly Easy. 3rd Edition. Wolters Kluwer; 2019.

University of Michigan Health. Speech and language milestones, birth to 1 year .

Centers for Disease Control and Prevention. Important milestones: Your baby by nine months .

American Academy of Pediatrics. Language delays in toddlers: Information for parents . Healthychildren.org.

Nemours Kids Health. Communication and your 1-to-2 year old . KidsHealth.org.

NAPA Center. Speech therapy for children: What are the benefits? .

Garro, A. Early Childhood Assessment in School and Clinical Child Psychology . Springer; 2016.

Ross, K. Speech-Language Pathologists in Early Childhood . Plural Publishing; 2015.

DeVeney SL. Clinical challenges: Assessing toddler speech sound productions . Semin Speech Lang. 2019 Mar;40(2):81-93. doi: 10.1055/s-0039-1677759.

NAPA Center. 5 tips to help your toddler’s speech development by a speech therapist .

Wooster Community Hospital. At what age should speech therapy begin? .

MDsave. Speech therapy visit .

American Speech-Language-Hearing Association. Introduction to Medicaid .

By Brandi Jones, MSN-ED RN-BC Jones is a registered nurse and freelance health writer with more than two decades of healthcare experience.

Early Intervention Speech Therapy

Speech-language pathologists using early speech intervention can address those problems at the source with life-changing therapeutic interventions that make a difference for those children and their families.

So, what is early intervention speech therapy and what age is early intervention for speech? Let’s look at how early intervention SLP works.

• Emerson College - Master's in Speech-Language Pathology online - Prepare to become an SLP in as few as 20 months. No GRE required. Scholarships available.
• NYU Steinhardt - NYU Steinhardt's Master of Science in Communicative Sciences and Disorders online - ASHA-accredited. Bachelor's degree required. Graduate prepared to pursue licensure.
• Arizona State University - Online - Online Bachelor of Science in Speech and Hearing Science - Designed to prepare graduates to work in behavioral health settings or transition to graduate programs in speech-language pathology and audiology.

What Is Early Intervention Speech-Language Pathology?

What is early intervention SLP and what is the earliest age for speech therapy? At its core, early speech interventionfocuses on diagnosing and treating speech disorders in young children—from infancy to age three. Early intervention speech therapy goals include addressing issues like stuttering, speech and sound disorders, speech delays, and voice disorders.

Because infants and toddlers haven’t yet developed the logic and reasoning of older children and adults, the therapies and techniques required for early speech intervention are much different than speech therapies for an older patient.

Studies have confirmed that early detection of speech and language difficulties, and subsequent treatment at the youngest possible age, can make a dramatic difference in ensuring positive outcomes for young patients.

Stuttering, for example, was one of the earliest disabilities the emerging field of speech-language pathology addressed, and it remains a significant affliction in early childhood and an important part of the SLP field.

Stuttering usually begins between the ages of two and five, and an estimated five percent of the population will struggle with the affliction. But effective early intervention speech therapy can reduce stuttering, as demonstrated by the Lidcombe early intervention program study which was shown to reduce syllabic stuttering by more than half over a nine-month period. Through such early intervention SLP, more than 80 percent of afflicted children lose their stutter before entering their teen years.

What Does an Early Intervention Speech-Language Pathologist Do?

What is the process of early intervention? First, an early interventionist must be able to diagnose conditions based on relatively few clues from their patient, as children lack the tools to communicate what they are feeling or experiencing. SLPs must look for indicators such as:

• The presence or absence of common baby talk sounds
• The patterns in which a child moves their lips and tongue
• The timing of an infant’s first words
• Difficulties in the formation of categories of sounds
• Sensitivity of nerves around the mouth to touch or temperature extremes

Combining subtle hints from those and other observations, as well as assessing risk factors for future speech-language issues, the SLP then develops an effective diagnosis, treatment plan, and prevention toolkit against the development of future disorders. Early intervention speech therapy goals include developing skills such as:

• Morphology and syntax

What does a speech therapist do in early intervention? Early intervention SLPs are often in the unique position of being able to incorporate games and play in the therapeutic process. Many children respond better to therapy couched as a game—and many speech therapies and diagnostic routines have the repetitive tone of a game anyway. Early intervention speech therapy activities include:

• Imitation and sound echoing games
• Physical therapies to strengthen the oral muscles, like blowing bubbles
• Object identification and verbalization using books, picture cards, or other materials

When children face speech issues at a young age, it is commonly the result of other diseases or disabilities, such as autism, cerebral palsy, deafness, or apraxia. Consequently, an early intervention SLP often works as part of a multidisciplinary care team, discussing treatments and developing a long-term action plan with other medical and education professionals.

Early intervention SLPs must also be able to communicate effectively with parents and immediate family members who may be having serious difficulties themselves coping with the situation or even understanding what early intervention therapy’s role in their child’s success is. It’s important to be able to educate families on treatment strategies and the best way to support children who may still be in prelinguistic phases of development.

How Can I Become an Early Intervention Speech-Language Pathologist?

Your BA will prepare you for the next step, which is earning your master’s in speech-language pathology. Most states require a minimum of a master’s degree in order to become clinically licensed to practice. Your graduate program is where you can specialize in early intervention speech therapy, taking courses specific to diagnosing and treating children under age five. Your program will also include a clinical practicum, which is a precursor to your clinical fellowship.

After earning your MA or MS in speech pathology, you’ll embark upon your fellowship. During your clinical fellowship, you’ll gain valuable field experience under the supervision of a licensed SLP before you can take the national Praxis exam to become eligible for your state license. Passing the exam allows you to then apply to your state’s licensing board to become an early intervention SLP.

Early Intervention Speech-Language Pathologist Job Outlook

Speech-language pathology careers are in very high demand—in fact, according to the U.S. Bureau of Labor Statistics , the field is expected to grow by 29% over the next decade. In large part due to the expanded understanding of various developmental and behavioral conditions, such as autism spectrum disorder (ASD), SLPs are highly valued for their ability to induce significant progress in disorders that have historically been unresponsive to traditional cognitive or physical therapies.

Especially because of how integral the earliest childhood years are to a person’s eventual adult development, early intervention speech therapy is that much more critically necessary. Speech-language pathologists also enjoy very comfortable pay—the 2020 BLS data placed the median salary at $80,480.

Start Your Early Intervention SLP Career

Through early speech intervention, you can radically change the trajectory of a child’s life for the better, affecting far beyond just their childhood years. It starts with an accredited SLP degree program that will give you the solid foundation you need to become a difference in your patients’ lives. Learn how to become a speech-language pathologist today.

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• Career Resources
• How to Become a Speech-Language Pathologist
• Both Sides of the Frenectomy Debate
• Certification
• State Licensing Overview
• Student Resources
• What is Speech-Language Pathology?
• CAA-Accredited Graduate Programs
• Directory of CSD and SLP Undergraduate Programs
• Master’s in Speech-Language Pathology
• SLP Clinical Fellowship
• SLP Thesis Track
• 2022 SLP Scholarship Guide
• 2022 Top SLP Master’s Programs
• Practice Settings
• Private Practice
• Telepractice
• Specialty Areas and Disorders
• Ankyloglossia (Tongue Tie) and Lip-Tie Issues
• Aphasia (Post Stroke)
• Apraxia of Speech
• Augmentative and Alternative Communication (AAC)
• Child Language Disorders
• Communication Competency Assessment
• Early Intervention
• Fluency Disorders
• Forensic Speech-Language Pathology
• Laryngeal Imaging
• Late Talkers
• Low-Incidence Disorders
• Multilingual Patients
• Occupational Therapy
• Otoacoustic Emissions Screening
• Patients with Autism
• Patients with Cochlear Implants
• Percutaneous Electrical Stimulation (E-stim)
• Public Health
• Rehabilitation
• Spasmodic Dysphonia
• Stuttering and Cluttering
• Swallowing and Feeding Disorders (Dysphagia)
• Transnasal Esophagoscopy and Pharyngeal/Esophageal Manometry
• Transgender Voice Modification Therapy
• Voice Therapy
• Dual Certification in SLP and Lactation Consultancy
• Continuing Education is Key to Career Versatility and Longevity in This Field
• Do You Speak with an Accent? … You Can Still Be an Outstanding SLP
• The Challenges and Rewards of Working with English Language Learners
• Some Advice on How to Approach Your Clinical Fellowship
• 4 Things a Job Description Can’t Tell You About the Profession
• 5 Things I Love Most About Being an SLP
• Your Guide to Getting Started in Telepractice
• Why Team Player SLPs are Even More Effective Than Superstars
• Why Working With the Entire Family Gets the Best Results in Kids Struggling with Speech-Language Issues

What You Need to Know: Early Intervention

Rebecca Parlakian

• July 12, 2018

Babies have lots of new skills to learn—lifting their heads, sitting up, saying their first words! Parents are often concerned when a child’s development seems slower than expected. Grandparents or child care providers may also voice concerns. If you’re worried that your baby is delayed in his development, it’s a good idea to share your concerns with your health care provider. Your community’s early intervention program can also be an important source of help.

What is “early intervention”?

The idea behind early invention is that a child’s developmental delays can be addressed best when they are discovered early. The Early Intervention Program for Infants and Toddlers with Disabilities (also known as Part C) is a federal program that provides for services and supports to children birth through 2 years old at risk for developmental delays or disabilities. These services can include speech–language therapy, occupational therapy, physical therapy, assistive technology, and more.

How do families contact early intervention?

You can request an early intervention evaluation for your baby or toddler to find out if your child qualifies for services. To locate the right agency in your community, see the  Centers for Disease Control and Prevention online  list.  You can also ask your child’s health care provider how to contact your local early intervention program.

When you call, explain that you are concerned about your child’s development and think your child requires early intervention services. Tell them you would like child to have your child evaluated under Part C of IDEA (the Individuals with Disabilities Education Act).

Each state chooses how it determines eligibility for early intervention services. Most states require that children show a certain level of developmental delay to qualify. The evaluation will determine whether your child is eligible for services.

Some children are automatically eligible for early intervention services. This may include children born prematurely or diagnosed with a developmental issue before or immediately after birth. To learn more, contact your local early intervention program or ask your child’s health care provider.

Is there a cost?

There is  no charge  for an early intervention evaluation to determine if your child is eligible for services.

Depending on your state, there  may  be a charge on a sliding scale for services such as speech–language therapy, occupational therapy, or physical therapy. However, children cannot be denied services because their families are unable to pay.

What services can children and families receive?

If your child’s evaluation shows that she qualifies for services, then you and your child’s early intervention service coordinator will develop a plan for services. This plan is called the Individualized Family Service Plan (IFSP).

The IFSP will include important information such as:

• your child’s current levels of development
• developmental goals for your child, which you help to identify
• what services your child and family will receive—such as home visits from a special educator, speech–language therapy, occupational therapy, and physical therapy
• when and how frequently your child will receive each service
• where your child will receive these services. Services are often provided in your child’s “natural environment”—such as your home or your child’s care setting

Your service coordinator will explain the IFSP to you. Ask any questions you might have. This meeting is also the time to ask for additional services that you believe may benefit your child and family. You must sign a form giving consent for each service your child receives. If you do not give consent, your child will not receive that service. The state has 45 days to complete the evaluation and IFSP process. This deadline means that your child will receive the services he needs as soon as possible.

Your child’s IFSP is a plan for her learning while in the early intervention program. You and your service coordinator will review the IFSP every 6 months and update it each year.

Does receiving early intervention mean that children enter special education later on?

No. Some families worry about participating in early intervention because they don’t want their child to be “labeled” when she enters school. But information about your child’s participation is not shared with her elementary school.

Children receive services for different lengths of time, depending on what they need. Some children participate for a short time to address a temporary delay in development. Other children may require follow-up special education services once they enter school.

If your child continues to be eligible for services past 3 years old, he will move from early intervention to special education services (or, from Part C to Part B). Your service coordinator will help you make the transition from one program to the next.

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The Importance of Early Intervention for Speech and Language Disorders

Perhaps your child is a late talker or maybe your child has difficulty following directions or answering questions. Or perhaps your child has difficulty pronouncing specific speech sounds. Have you ever wondered whether your child might be delayed in their speech or language skills relative to other children their age? If you have agreed with any of the above statements, you should connect with an experienced Speech-Language Pathologist (SLP) to assess your child’s speech and language skills. 

When it comes to speech and language skill development, early intervention offers the best outcome for children who may be behind in these skills. It is never too early to meet with a speech and language pathologist to identify whether speech therapy would be beneficial for your child. 

If you are unsure about whether your child is on track with their speech and language skill development, don’t wait for your child to fall behind. Getting started with speech therapy as early as possible means that your child will receive the support and guidance they need before any communication challenges appear, ensuring they continue to develop as they should. Don’t wait to get your child started with speech therapy, getting started is as easy as scheduling your free introductory call today! 

What is Early Intervention?

Each individual child grows and develops at their own rate. While some children may walk and talk early, others may learn certain skills at a delayed rate. If a parent has any concerns about their child’s development, the earlier they seek help for their child, the better. Early intervention for speech and language development is available in every state under federal law. In some states, early intervention programs can continue until the child reaches the age of 5.

Loved ones, caregivers, and care professionals, including audiologists and speech and language pathologists, are typical elements of an early intervention team. Speech therapy for early intervention can help children develop skills such as: 

• Cognitive Skills (Learning, Thinking, Problem-Solving)
• Communication Skills (Speaking, Listening, Comprehension, Gesturing)
• Social Communication Skills (Conversation, Understanding and Interpreting Others)
• Nonverbal Communication (Gestures, Tone of Voice, Facial Expressions, etc.) 

Early intervention speech therapy is different for each individual child and their family and will depend on the specific needs of the child as well as the family’s priorities. The most important thing is to start speech therapy as early as possible. 

The Problem with the “WAIT AND SEE” Approach 

Many parents whose children are developing as they should in every other aspect (social skills, play skills, fine and gross motor skills, etc.), have been told by others “not to worry” about their child’s speech and language development. It is common for parents to be told to just “wait and see” if their child outgrows their speech or language delay and to simply ‘hope for the best.’ 

While it is true that children develop at their own pace, and acquire skills in varying order, speech, and language pathologists know when certain milestones should be reached by a specific age. When a child does not reach these milestones by a certain age, this can be cause for concern and, without the benefit of early intervention speech therapy, can cause more challenges further down the road. Get started with Great Speech by scheduling your free introductory call today!

What Does the Research Say about Early Intervention Speech Therapy? Why is language development so important in early childhood?

Studies have suggested that as many as 70-80% of delayed talking toddlers will outgrow a language delay if it is an expressive delay, which means that a significant number (20-30%) will not be able to catch up to their peers without intervention. Research has shown that when children aren’t able to catch up in their language skills, they may experience persistent language difficulties, as well as difficulties related to reading and writing when they reach school age. It can be very difficult to identify which late talkers will catch up and which will not be able to catch up on their own. Experts have suggested that the “wait-and-see approach” is not a recommended approach when it comes to language development. Waiting to seek intervention can put off important treatment that can make a major difference to a child in a wide variety of ways.  

What are the Benefits of Early Intervention?

Early intervention does not just involve a treatment plan for the child, but also it involves education, support, and guidance for parents and caregivers. Early intervention can have a profound effect on your child’s speech and language development. Early intervention can help to improve the child’s ability to communicate, effectively interact with others, and strengthen their social skills and emotional regulation. There are many important reasons to intervene early. 

Brain Development – The majority of young children will develop most of their speech and language skills by the age of three. During this time, learning and developing communication skills can influence how the brain develops. Early intervention is highly important because infants, toddlers, and preschool-aged children have developing brains that are configured to learn and adopt communication skills. If there is a problem with the development of these skills, speech therapy should begin as soon as possible to capitalize on this essential period of normal brain development.

Elimination – A young child may be able to develop appropriate speech or language skills, although this is almost impossible to predict for the majority of young children. The cause of delayed speech and language skills isn’t always easily identified and the speech and language pathologist can’t accurately predict the course of development for each child. With early intervention, many children will develop their speech and language skills and will be able to catch up to their peers before beginning school. The speech and language pathologist can effectively assess and provide treatment for specific speech and language disorders which can in turn be quickly eliminated through early intervention.

Remediation – This element of early intervention speech therapy involves improving communication skills through play and practicing daily routines with the child. Remediation is the most common outcome and goal through speech therapy intervention for young children with potential communication delays. Working to become a more effective communicator will help the child to effectively and confidently communicate with adults and peers and can also reduce frustration and negative behaviors.

Parents Play An Essential Role – During early intervention speech therapy, parents are supplied with the tools and techniques that they need to facilitate speech and language development at home. Parents and/or caregivers are at the heart of early intervention as they provide the necessary language models every day that children require in order to develop language and communicate effectively. Through early intervention, parents can also be taught essential early language strategies to equip them to facilitate their child’s speech and language development through play, reading books, and during daily routines such as mealtimes and bedtime. Parents may also be taught specific cueing or feedback strategies to support their child’s production of specific speech sounds.

If you have any questions or concerns about your child’s speech and language skills, don’t wait to seek the support of a speech and language pathologist. Getting started with Great Speech is as simple as scheduling your free introductory call today! 

The Importance of Early Speech Intervention

Every child develops on their own timeline. This is true with crawling, walking, potty training, and talking.

When it comes to speech, language, and communication, it’s common for children to need extra help meeting developmental milestones expected for their age. That’s why it’s so important for parents, caregivers, and teachers to know how to spot the early signs of a speech delay. 

The earlier a child receives speech therapy intervention, the more quickly they can make progress. Early intervention can also decrease the severity of their speech delay over time.

In this article, we review how to identify some early warning signs of a speech-language delay, what developmental milestones to track, and the benefits your child will receive from early speech therapy services .

What are the signs of a speech delay?

While it may seem counterintuitive, you can actually spot many signs of a speech delay before a child even says their first words. Monitoring the milestones for nonverbal areas of communication can help reveal if a child is on track to begin speaking on time. Each of these nonverbal examples is linked to a child’s eventual language development:

Joint attention (a person’s ability to focus on a shared object or event with another person)

Eye contact

Play skills

The ability to vocalize back and forth through babbling or other utterances

You may be wondering at what point your child should be meeting these preverbal and verbal communication milestones. Check out the helpful milestone chart below broken down by age. You may not have realized that all of these skills are tied to speech and language development!

Babbles and makes various sounds

Turns head toward a sound

Mouths toys

Makes consistent eye contact by 6 months

Waves “bye-bye”

Begins to babble repeated sounds like “mama,” “dada,” or “baba”

Responds to simple activities like “peek-a-boo”

9-12 months

Gives objects upon request

Says “Mama” or “Dada” meaningfully

Begins imitating some animal sounds or environmental sounds

Begins to understand the word “no”

Says first meaningful word

Responds to name

Seeks attention from others

Joint attention should emerge around 9 months

12-18 months

Uses toys/objects appropriately (talks on toy phone, drives a toy car, etc.)

Follows one-step directions

Sits and attends to a book

Uses some words independently

Identifies body parts

Can play in a task with another person for 1-2 minutes

Demonstrates functional play, and using two objects together in play

18-24 months

Points to common objects

Understands at least 50 words

Asks for “more”

Imitates words readily

Uses at least 5-10 words spontaneously

2 years old

Follows two-step directions

Asks for help or assistance

Uses two-word phrases

Plays independently and watches other children

3 years old

Identifies parts of an object (such as the wheel on a car)

Relays daily experiences

Identifies complex body parts (wrist, knee, ankle, eyebrow, etc.)

Speaks in sentences

Speech is 80% intelligible, or able to be understood

4 years old

Answers “what,” “when,” and “where” questions

Plays appropriately with other kids

Understands concepts like “long” and “short” and other descriptive words

Speech skills build upon each other

When it comes to starting speech therapy intervention, one important thing to note is that all speech skills build on each another in a sequential order, a bit like a staircase. 

A child typically does not make it up each “stair” without first accomplishing the one before. Here’s a simple example: Before a child begins using sentences, they first need to use single words. If a child is 2 years old and isn't using single words, they are already about one year behind. If, for example, your child does not receive speech intervention for another year, and they haven’t caught up in this area on their own, then they will be about two years behind, since short sentences should begin around 2.5 to 3 years old. 

You can save a lot of time, frustration, and anxiety if you receive professional intervention earlier rather than later, reducing the lag your child experiences in reaching these important milestones. 

How speech and language relates to school success

One thing many people don’t realize is that strong speech and language skills can be tied to educational and academic success . 

When a child begins to grow familiar with words and increases their receptive language skills, they are also learning to listen to the similarities and differences between the structure and sounds of words. This correlates to phonemic awareness skills. Early phonemic awareness (the recognition of speech sounds) is directly linked to early reading success. We want children to be able to identify words that rhyme, and even the sounds that make up words, as they get older and closer to reading age. 

If a child struggles with recognizing sounds, this could be a sign that reading may be a challenge for them later on.

The benefits of working with a speech therapist

A licensed speech therapist is the best route to go when seeking help for your child’s language development. If your child has a speech therapist that sees them consistently, the therapist will understand your child’s communication strengths and weaknesses inside and out. This is helpful when it comes to setting appropriate goals for your child.

At the end of each session, your speech therapist should provide an overview of how your child is progressing. They should also provide specific, weekly home exercises and activities that target exactly what your child needs to practice. Practice at home is extremely important. It helps your child maintain their progress between sessions. This way, your child isn’t just practicing their speech and language skills for 30-60 minutes a week, but around the clock, during their everyday life. 

Speech therapy can help your child's social and emotional wellness

When children are clear and confident communicators, this greatly helps increase their self-esteem . Think about it: What if you were unable to communicate your thoughts, needs, and wants to other people? What if others had to constantly say, “What?” or ask you to repeat what you said every time you spoke? You'd likely feel quite frustrated. You might shy away from speaking to others, avoid social situations, and deal with feelings of embarrassment or isolation.

The same is true for kids. Strong communication skills help them express their basic needs and form relationships with family and peers. That’s why addressing these issues with professional help early on, before they worsen over time, is so important.

Don't wait

If you're concerned about your child's speech, trust your instincts. Ask your child's pediatrician for a referral, or reach out directly to a speech therapist for a speech and language evaluation .

Discuss your communication needs with a speech therapist for free

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• Early Intervention for Speech and Language Therapy

In this article we are talking about Early Intervention for Speech and Language Therapy, and how it can Change the Trajectory of Your Child’s Long-Term Communication Skills

What is Early Intervention?

Early intervention (ei) is the treatment of developmental delays in children 3 years of age or younger..

In regards to receptive, expressive and social/pragmatic language development, the first 3 years are critical to the trajectory of a child’s long-term communication skills. This portion of time is so critical due to the rapid development taking place in the brain at this particular age. 

When first noticing a delay in their child’s communication skills, some parents may feel or be told that what their child is going through is “just a phase” , that they will “grow out of it” or that they should wait until their child starts school. However, research tells us that intervention before the age of 3 is more effective than treatment after the age of 3.

Believe it or not, after 3 years old, most major areas of the brain have already reached maturity! Treatment taking place before this critical age can increase the effectiveness of being able to make significant transformations in a child’s development and progression.

Additionally, EI for speech/language has been shown to increase skills in literacy, behavior, learning and social/pragmatic skills in the long-term. 

When it comes to EI, the earlier you start, the better the prognosis!

So how does a parent go about getting their child the help that they need right away?

How get started with Early Intervention Speech and Language Therapy

Get a referral.

Early intervention starts with a referral from your child’s pediatrician.  It is important to communicate any concerns that you have for your child’s development to their primary care provider, whether it be speech and language, feeding/swallowing, fine/gross motor skills, social-emotional skills, aversive behaviors or concerns for overall neurological development.

Contact a Service Provider

Once you have a script or referral from their pediatrician indicating a need for formal speech/language evaluation and treatment, you are ready to contact a service provider to schedule the initial speech-language evaluation.

For most initial evaluations before the age of 3, the process will look like a parent interview of your child’s birth and medical history and an inventory of your child’s speech and language skills. It will also likely include a clinical observation and assessment of your child during play and conversation with a Speech-Language Pathologist (SLP).

What does Early Intervention Speech Therapy look like?

Once it is determined that your child is eligible for speech/language services, the treating Speech Language Pathologist (SLP) will work with you to come up with a plan to best support your child’s individual needs. 

In the beginning, treatment might be challenging. For most children, this is the first time that they are having structure and demands placed on them. Your child may be resistant at first and you may even see an increase in aversive behaviors, depending on your child. However, it is crucial that these demands be met with consistency and follow-through in order to see progress.

Early Intervention is centered around play, but involves cooperation and elicitation of communicative intent and the use of more appropriate forms of communicating. Your child may start by learning simple gestures for choosing, requesting and refusing or they may be at the level that they will be expected to use single words (ie: “want”, “ more”) or even carrier phrases (ie: “I want + object/toy”, “more + object/toy ”, “All done+ object/toy” in order to communicate their wants and needs.

In addition, your child may work on following directions, identifying/labeling common vocabulary, joint attention skills, cooperative, functional and pretend play skills, along with many other things, depending on their specific needs.

Intervention + Carry-over Techniques = a Recipe for Success!

Perhaps even more crucial to the success of your child’s speech and language development is the carry-over work that happens at home and other settings outside the clinic. Even with the most intense of speech-language therapy, the SLP is only seeing your child for a few hours per week.

As parents, you are with your child the rest of the time. Carry-over techniques, or what Always Keep Progressing clinicians refer to as “homework” for your child, are imperative to the generalization of the skills they learn while in the clinic. It is important that the entire household, close relatives who spend a lot of time with your child, daycare/preschool staff and teachers and other interventionists working with your child are up to speed on your child’s goals. Consistency is KEY for reinforcing the responses, behaviors, and skills that your child needs to develop in order to become a successful communicator.

References and Helpful Information for Parents

PDF – The Importance of Early Intervention – First Words Project

The Hanen Centre – Starting early: Why it’s so important

ASHA – Early Intervention

Article Written By:

by Michelle Mendez, M.A., CCC-SLP – Speech and Language Pathologist at Always Keep Progressing

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• Stepping Out of Your Comfort Zone with Early Intervention Therapy »

Stepping Out of Your Comfort Zone with Early Intervention Therapy

• January 13, 2023

As a parent, you might have heard the phrase “just give your child time” and “just wait and see” whenever you express your concerns about a possible delay in your child’s development . While children exhibit different developmental milestones and are often able to catch up with their peers, some may need medical interventions to help provide strategies to achieve their milestones.

Most children with speech sound errors including articulatory difficulties (sound errors) need specialized intervention to achieve certain speech milestones and to increase how well others understand them. Seeking early intervention speech therapy is a great move towards improving the quality of your child’s life.

What is Early Intervention Speech Therapy?

Early intervention speech therapy focuses on the diagnosis and treatment of speech and language disorders and delays in children aged between infancy and typically 5 years. These delays and disorders can include motor speech disorders such as apraxia , speech sound errors that impact their overall production of words, a lisp, voice disorders, receptive language delays and disorders such as following directions, pointing to items when named, and expressive language delays and disorders such as meeting vocabulary milestones and effectively communicating their wants and needs with minimal frustration.

Even though early speech intervention procedures often target infants and toddlers, they can be carried out until your child is able to communicate effectively. However, the earlier you begin early intervention speech therapy, the better off your child will be as you are providing them different strategies that work best for them to achieve communication milestones while teaching you as a parent how to carryover the strategies at home during everyday activities and daily routines to assist in increasing the exposure to the strategies that best work for them.

How to Get Started With Early Intervention Therapy

Once you have noticed your child has a speech difficulty including being hard to understand them or others not understanding your child, its best to seek out strategies and help from a speech therapist to begin assessing what sounds to work on, and how best to increase their clarity of words so everyone can understand them including peers. Many parents often don’t know how to get started. So we are going to detail it for you:

• Contact Milestone Therapy Group or your pediatrician. If contacting your pediatrician, explain to the pediatrician the nature of your concern regarding your child’s speech and the need to obtain a speech and language evaluation from a professional Speech Language Pathologist. Your pediatrician can refer your child to Milestone Therapy Group for speech therapy. 
• Next, book an appointment with our speech therapist. They will examine your child and ask you important questions about his or her speech history, before providing a diagnosis that reflects the difficulty and any therapy recommendation.

The Importance of Early Intervention Therapy

Early intervention speech therapy can have a significant impact on your child’s social and emotional wellness. Children who are good communicators and understand their communication partners are more confident and can interact with friends in daycares, preschools and during community outings such as playgrounds. However, those with speech difficulties and language difficulties can be timid and move away from peers not attempting to express themselves or their needs. Early intervention speech therapy can help your child achieve strategies to assist them in interacting with peers, friends, teachers, and family impacting their overall quality of life.

In addition, early intervention speech therapy can also increase a child’s comfortability and success at school. Children who can correctly differentiate and understand sounds are able to develop phonemic awareness. Phonemic awareness contributes to improved reading and spelling skills. Building language skills early on will assist in answering questions and participating in classroom activities.

Early intervention also helps to resolve developing speech and language difficulties in children. Some speech sound errors and difficulties, if left untreated, are harder to correct as the longer the child practices the incorrect speech sound, the longer and harder it will be to change that speech pattern.

Don’t Wait!

Whenever you feel uneasy or worried about your child’s speech development milestones, don’t sit back and wait for fate to take its course. Step out of that comfort zone and book an appointment with the best speech therapy for toddlers and early preschoolers near you, such as the tried and tested Milestone Therapy Group . If you are in the Philadelphia or Main Line area, don’t hesitate to do a quick Google search of child therapy services in Philadelphia and/or Main Line and choose a suitable speech therapist for your child.

When it comes to speech challenges with children, taking chances isn’t an option. 

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Early Intervention Speech Therapy Activities To Try at Home

Worried about your child suffering from speech or articulation delay?

There are lots of activities that may help their progress.

You may be surprised to know this, but even the simplest games and objects will help inspire your little ones into talking.

You just need to get creative at home and make learning fun to engage them in sneaky at-home therapy sessions.

Today, we’re going to look at the importance of early intervention and recommend some ideas for early intervention speech therapy activities you can do at home.

What Does Early Intervention Do for Speech?

Speech therapy activities for you to try at home, early learning fun, why is early intervention important for speech and language.

Speech problems can sometimes lead to behavioral problems due to your child’s frustration at not being able to communicate.

Research also suggests that early intervention can help support the skills needed for reading and writing later down the line.

Early intervention could help eliminate articulation errors and improve brain development, as well as enhance your child’s ability to communicate overall.

It can also give you, the parent or carer, more control.

Eliminate Articulation Errors

The first way that early intervention could potentially improve your child’s speech is to eliminate articulation delays.

Correcting articulation errors earlier is shown to be much more effective than trying to fix them later.

Improve Brain Development

Speech and language skills are developed most when your child is between three months and three years old .

Because infant and toddler brains can assimilate information much faster, you must take advantage of this time.

You would want to teach them as much as possible during this faster-learning period of their lives.

Improve Communication

Early intervention can also help improve your child’s overall means of communicating.

The earlier they learn to speak, the earlier they will also learn to interact with others in play situations, as well as with adults and peers.

Children who aren’t able to communicate verbally can be set compensatory strategies to help them express themselves in other ways.

Teaching a child American sign language or giving them picture cards to use will allow them to communicate with you and others.

It can help reduce potential frustration at not being able to communicate while verbal aspects of language are developed further.

Gives You More Control

Early intervention speech therapy will also give you the knowledge and tools you need to help you feel more in control.

As parents or carers, you play a crucial part in your child’s speech and language development as their primary language role models.

Early intervention speech therapy will teach you strategies to use in your daily life to help ease your child into speaking.

Early Intervention Speech Therapy Activities

Early intervention speech therapy relies heavily on parents being more involved with their child’s speech and language development.

Depending on your child’s speech problems, it can make a huge difference in their future ability to communicate.

Early intervention also impacts both their academic and personal lives in the future.

Still, all children learn at their own pace, and if your child isn’t talking as quickly as the other kids, it’s not necessarily something to worry about.

Early intervention is recommended over a “let’s wait-and-see ” approach for many reasons.

There are lots of ideas for speech therapy activities you can try at home with your child, and it’s never too early to start.

Infants Zero to One-Year-Old

When your child is in infancy, it’s important to talk to them often, even though they are not yet talking back.

Take them for walks in their stroller and talk about all of the things you can see together, leaving pauses in the conversation for them to “answer.”

You can talk about the colors you see, the trees, birds, flowers, or dogs running around the park.

They will enjoy listening to the sound of your voice and will learn instinctively about how conversations flow back and forth.

They may also start babbling in the appropriate places, so you can tell that they are trying to be involved.

Lay a blanket on the grass or floor and give them some tummy time while you talk to them, read a story , or sing to them.

Music and songs will also help you learn more about their speech comprehension, especially as they get older.

The repetition will help them learn and recognize melodies and even some words.

You may notice their excitement as you start to sing one of their favorite songs.

Incorporating actions also builds anticipation for a moment in the song when they know you’re about to swing them around or tickle them.

Teaching them simple sign language for words like “more” and “finished” can also help them learn to express themselves to you earlier.

Children as young as eight months are sometimes able to remember and perform very simple signs.

Studies have also shown that teaching sign language to babies when they are preverbal can help to speed up speech development.

Toddlers One to Three Years Old

Talking, reading, and singing with your child should be kept up throughout their early years of development and beyond.

Invest in some inexpensive toys to use as props in your activities together.

We recommend some miniature vehicles you can take on “drives” together (after you say “ready-steady-go,” of course).

Small plastic animals are also great because of the sound effects you can create together when playing with them.

You can encourage your child to make the sound effects of the vehicles and animals before later moving on to their names and action words.

What’s more, never underestimate the power of bubbles. Even if all else is failing, bubbles just might be able to save the day.

Blowing bubbles with your toddler will not only mesmerize them but also help them practice their “b” and “p” sounds as the “bubbles” go “pop.”

Preschoolers Three to Five Years Old

Turn your pillowcase into an endless source of amusement by filling it up with “mystery” items.

There is literally so much you can do with just a pillowcase.

Have your child stick their hand in the pillowcase and see if they can guess what’s inside before naming the object and pulling it out.

Stick to easy and familiar objects so that they can win easily and feel accomplished.

Playing with different colored balls can provide lots of entertainment, too.

You can sort them out into colors, count them, and play with them.

You can try asking them the ball’s color or requesting a specific color to be rolled or thrown across the room to you.

The balls can even go in the pillowcase as you ask, “ Can you guess which color I’m going to pull out next? ”

If you have some picture flashcards at your disposal, you can also try and hunt for objects that match the pictures on the cards.

Doing this will help encourage language comprehension and articulation as you say each new word together.

Alternatively, you can collect some items together and put them in a box.

Show your child a series of flashcards to which they can match the picture they see with an object from the box.

You can have all of the objects in the box start with the same letter and label the box with that letter (the “d” box with dog, dolly, and dinosaur in it).

That way, you’re helping prepare your child for school as they also learn about phonetics.

Remember to always show enthusiasm for your child, whether it’s to show them how well they are doing or for at least trying!

Related: Speech Therapy Activities: Language Development and Fun Learning for Children

If an activity that you and your child do together involves talking, listening, singing, reading, or playing, then it will be good for their speech development.

Some children get bored more easily than others, but holding their attention can be as simple as changing your location in the home.

Don’t forget that your child has a lot of energy to expend.

So, even if you’re feeling tired, try to think of games that will have them running or jumping around.

It’s important that you keep early intervention speech therapy activities fun to make the biggest impact on your child’s learning and development.

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Speech and language therapy interventions for children with primary speech and/or language disorders

Newcastle University, School of Education, Communication and Language Sciences, Queen Victoria Road, Newcastle upon TyneUK, NE1 7RU

Jane A Dennis

University of Bristol, Musculoskeletal Research Unit, School of Clinical Sciences, Learning and Research Building [Level 1]Southmead Hospital, BristolUK, BS10 5NB

Jenna JV Charlton

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:

To determine the effectiveness of speech and language therapy interventions for children with a primary diagnosis of speech and/or language disorders. The review will focus on comparisons between active interventions and controls.

Description of the condition

Speech and/or language disorders are amongst the most common developmental difficulties in childhood. Such difficulties are termed 'primary' if they have no known aetiology, and 'secondary' if they are caused by another condition such as autism, hearing impairment, general developmental difficulties, behavioural or emotional difficulties or neurological impairment ( Stark 1981 ; Plante 1998 ). Although some children have either a primary speech disorder but not a language disorder, or vice versa, these disorders commonly overlap. In addition, interventions in both cases share commonalities; for example, focusing on various elements of the language system and common underlying processes such as attention and listening. Therefore, in both research and intervention, it is difficult to tease speech and language disorders apart.

It is thought that approximately 5% to 8% of children may have difficulties with speech and/or language ( Boyle 1996 ; Tomblin 1997 ), of which a significant proportion will have 'primary' speech and/or language disorders. The presentation of primary speech and/or language disorders can vary considerably between individuals in terms of severity, pattern of impairment and degree of comorbidity ( Bishop 1997 ). Questions have been raised in recent years as to how 'specific' to speech and language these problems are, but this distinction between primary and secondary difficulties remains clinically useful and is one commonly reported in the literature ( Bishop 1997 ; Leonard 2014 ; Reilly 2014 and associated papers).

Given the heterogeneity of presentation, there are inconsistencies in terminology for speech and/or language disorders with no agreed diagnostic label. The term 'language disorder', as used in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM‐5 2013 ), has been found to be problematic, as it identifies too broad a range of conditions ( Bishop 2014 ). The term 'specific language impairment' is the most commonly‐used diagnostic label, 'specific' referring to the idiopathic nature of the condition. However, this term is problematic in that it suggests difficulties are specific to language only. Disagreements about terminology impede research and clinical processes as well as access to services ( Reilly 2014 ), and differences in diagnostic categories/labels have implications for the current review, meaning that a wide range of different terms are expected across the literature. For the purpose of the current review, however, impairments in speech and language will be referred to as 'speech and/or language disorders', reflecting the possibility that children may have impairment in both or either of these areas.

Primary speech and/or language disorders can affect one or several of the following areas: phonology (the pattern of sounds used by the child), vocabulary (the words that a child can say and understand), grammar (the way that language is constructed), morphology (meaningful changes to words to signal tense, number, etc.), narrative skills (the ability to relate a sequence of ideas), and pragmatic language (the ability to understand the intended meaning of others and to communicate effectively in conversation ( Adams 2012 )). As regards the current review, the majority of these affected areas may be categorised as a 'language' outcome, with 'phonology' categorised as a separate outcome. It is unclear whether primary speech and/or language disorders represent varying levels of a single condition, or a number of different conditions with diverse aetiologies but similar presenting patterns ( Law 1998 ; Tomblin 2004 ).

There is little consensus on the aetiology of primary speech and/or language disorders but there is evidence of a number of associated risk factors, including medical difficulties (for example, being born small for gestational age), and motor skill deficits ( Hill 2001 ). There is increasing evidence of genetic underpinnings of speech and/or language disorders ( SLI Consortium 2004 ; Bishop 2006 ); the links appear to be stronger for expressive language difficulties than receptive language difficulties ( Kovas 2005 ). There remain questions as to the nature of the role of environmental factors, whether distal (for example, socioeconomic status and maternal education) or proximal (for example, parent‐child and peer‐peer interaction and relationships) as causes of primary disorder, or whether these are factors affecting outcomes (mediators). Twin studies have so far suggested that heredity plays an increasingly strong role, especially as the child moves through primary school and especially for less socially‐disadvantaged children, but that environmental factors can have a relatively important role to play in the early years, and that marked language difficulties between higher and lower social groups are identifiable from very early on in children's development and tend to persist ( Bradbury 2015 ). It is likely that these risk factors act in a cumulative fashion to increase the severity of the presenting disorder ( Aram 1980 ) and are relevant when it comes to affecting access to educational and therapeutic resources.

Primary speech and/or language disorders can have far‐reaching implications for the child and his/her parent or carer in both the short and the longer term. Studies indicate that they may have adverse effects upon school achievement ( Aram 1984 ; Baker 1987 ; Bishop 1990 ; Catts 1993 ; Tallal 1997 ). It has recently been reported that "approximately two children in every class of 30 pupils will experience language disorder severe enough to hinder academic progress" ( Norbury 2016 ). They may also be associated with comorbid social, emotional and behavioural problems ( Huntley 1988 ; Rice 1991 ; Rutter 1992 ; Stothard 1998 ; Cohen 2000 ; Conti‐Ramsden 2004 ), and with peer interaction difficulties ( Murphy 2014 ). Children with primary speech and/or language disorders can also have long‐term difficulties that persist to adolescence and beyond ( Rescorla 1990 ; Haynes 1991 ; Johnson 1999 ), with some 30% to 60% experiencing continuing problems in reading and spelling, and with early difficulties predicting adult outcomes in literacy, mental health and employability ( Law 2009a ).

Description of the intervention

Interventions for children identified as having primary speech and/or language disorders include a variety of practices (methods, approaches, programmes) that are specifically designed to promote speech and/or language development or to remove barriers to participation in society that arise from a child’s difficulties, or both. Assessment of eligibility for intervention includes a combination of standardised assessment (where available), observations of linguistic and communicative performance, and professional judgement. Interventions are usually time limited and can be delivered by any professional group, but usually involve input from language specialists, most notably speech and language therapists/pathologists. The criteria for inclusion in such interventions commonly includes some reference to the specific or the primary nature of the language difficulty experienced by the children concerned — that is, it is not associated with low non‐verbal performance — and this allows for a focus on speech and language characteristics rather than a broader range of skills.

Interventions for children with speech and/or language disorders may be carried out directly or indirectly, and in a range of settings, such as the home, healthcare service provision, early years setting (nursery/school), school or private practices, by the specialist professionals themselves or through proxies such as parents, teachers or teaching assistants. There are also examples where interventions are delivered through peers in school.

Direct interventions focus on the treatment of the child individually, or within a group, depending on the age and needs of the children requiring therapy and the facilities available. In group treatments, it is thought that children benefit from the opportunities to interact and learn from one another.

Indirect interventions are often perceived to be more naturalistic in approach, allowing adults that are already within the child's environment to facilitate communication. Traditionally, these approaches create an optimum communicative environment for the child by promoting positive parent‐child interaction. Indirect approaches are increasingly being employed within a range of settings where speech and language therapists train professionals and carers who work with the children, and provide programmes or advice on how to maximise the child's communicative environment and enhance communicative attempts.

Parents are often actively engaged in delivering interventions to younger children but tend to be less actively involved in the administration of the intervention as the child gets older. Many intervention models target behaviours using play to enhance generalisation. Interventions for children with primary speech and/or language disorders would, in many cases, meet the criteria for being a complex intervention ( Craig 2008 ), being made up of a number of elements that vary according to both the theoretical assumptions behind the intervention and the perceived needs of the child.

The majority of interventions involve the training of specific behaviours (speech sounds, vocabulary, sentence structures) accompanied by reinforcement. Most commonly this involves rewards of some form (stickers, tokens and, most often, praise). The assumption behind overt behavioural techniques is that language or speech can explicitly be taught and that gaps in the child's skills can be filled by instruction. In the past twenty years, most therapy has shifted from explicit training paradigms to those based on social learning theory, which assumes that children learn most effectively if they are trained within a social context ( Miller 2011 ).

As the child gets older the emphasis of interventions shifts towards a more functional approach, whereby children are taught skills that are most useful for them at that moment. This functional shift often involves a move from explicit instruction to a more 'meta‐cognitive' approach whereby the therapist will encourage the child to reflect on what they hear and then adopt it into their own repertoire. Often the therapist will present the child with alternatives and encourage them to make judgements based on their intrinsic grammatical or phonological knowledge. It is assumed that the process of making a judgement increases the child's chances of modifying their language and/or speech performance. 'Constructivist' or usage‐based explanations represent a new direction from a linguistic perspective ( Childers 2002 ; Riches 2013 ).

Speech and/or language therapy interventions vary in duration and intensity depending on the resources available, the perceived needs of the child, and policies of different speech and/or language therapy and educational services. The intensity and the duration of typical therapy interventions have yet to be evaluated systematically ( Warren 2007 ), although both of these issues have been raised as potentially important determinants of outcomes ( Law 2000 ; Hoffman 2009 ). In practice, some interventions are of short duration and relatively low intensity, for instance, six hours over a year. It is common for these short durations of intervention to be offered in 'blocks' of treatment, commonly once a week for a six‐week period. This may then be repeated depending on a child's progress — although there is no specific evidence underpinning this approach. In other instances, especially in schools, interventions may be delivered on a daily basis over a longer period. On balance, however, most speech and/or language interventions tend to be relatively short (less than 20 hours in total).

Treatment goals vary considerably depending on the perceived difficulty that the child is experiencing. While the focus is often on aspects of expressive language, many studies also focus on receptive language ability or verbal comprehension, and in the last decade there has been an increasing emphasis on pragmatic language difficulties (the way children use language with others). Treatment goals may focus on specific aspects of language or address a number of aspects of language in combination. For many speech and language therapists, the child's social skills and their ability to integrate with peers and negotiate the curriculum are key outcomes.

There have been a number of recent developments in intervention for children with primary speech and/or language disorders, listed as follows.

• An increased use of computerised intervention packages, and most recently 'apps' (short for computerised 'application'), in education.
• A move towards meta‐cognitive or meta‐linguistic interventions, especially for older children and often with a view to enhancing comprehension. These emphasise the child making judgements based on their underlying linguistic knowledge, and often use other, readily recognisable supports (that is, colour and shape).
• Increased emphasis on universal or public health interventions whereby speech, and especially language, interventions are provided for whole populations using key messaging to parents and training public health professionals (for example, Health Visitors in the UK) ( Law 2013 ).
• Increased focus on comorbidity, for example, the relationship between language skills and socio‐emotional skills , and whether interventions addressing the former may have outcomes relevant to the latter ( Law 2009b ).

How the intervention might work

There are some explicit elements in the mechanism of change that can be identified and that are likely to help identify the 'active ingredients' of any intervention both in terms of immediate and longer‐term benefits.

The delivery agent

Interventions, especially those for younger children, often involve the child's parents or caregivers. This creates an optimum communicative environment for the child by promoting positive parent‐child interaction. It can increase parental knowledge about speech and language development, including how they might target their child's language development at home. It also helps them provide 'carry over' or generalisation at home and then 'maintenance' over time. Similarly, training teachers and teaching assistants to carry out the intervention tasks has the potential to widen the child's opportunities to practice new skills. Targeted interventions are likely to be delivered by specialist practitioners such as a speech and language therapist/pathologist. Evidence does suggest that it may be less the category of person that is key here than the commitment of parents and the experience and training of the practitioner that makes the difference. This may be especially true for aspects of grammar and phonological development, where the specialist skills of the speech and language therapist/pathologists are likely to be of paramount importance.

The context of delivery

Intervention for children with speech and/or language disorder is carried out in a number of different contexts: the home, the clinic, the nursery/early years setting/kindergarten, the school, etc. Many of the interventions reported in earlier studies were 'clinical' in focus, in the sense that they were carried out in a clinic separate from school, perhaps with the parents in attendance or actively engaged. In practice, while this may still be true for many children when they first encounter specialist services, this type of 'pull out' model is much less common, and children are seen within settings where they spend most of their time. The rationale is that the context in which children learn language is critical for their outcomes and that maximising the most appropriate sort of intervention in the right environment is more likely to be effective in the long run than very specific intervention led solely by an adult 'expert'. That said, there may well be a case for this more specific, one‐to‐one intervention, especially with children who have more pronounced problems.

In recent years there has been an increased use of computer‐delivered intervention, effectively a mediated version of the adult 'expert' model. Computerised interventions work by providing very explicit links between the stimulus and the reward within the context of the game format in which they are presented. Due to their similarity to non‐educational computer games with which children are often familiar, these interventions are considered to have a positive effect on a child's motivation and engagement. Such approaches have been used widely where there has been limited access to specialist provision.

The intervention technique

Speech and language therapists commonly use a range of behavioural techniques, including imitation, modelling, repetition and extension. These draw the child's attention to the structure and the content of the speech or language input (or both), and the input is often presented at a developmental level a little ahead of that of the child. Stimuli are commonly repeated many times to draw the child's attention to the correct form. It is assumed that practice is one of the cornerstones of reinforcement and that repetition makes it easy for the child to learn what they have not otherwise acquired. Key to all intervention is building the child's motivation to speak.

Children with speech and/or language disorder are often described as having poor auditory skills. There has been an ongoing discussion as to whether the child's auditory skills are the key underlying problem or whether the breakdown is primarily linguistic in nature ( Bishop 2005 ), and there is individual variability in auditory processing skills, which must be recognised prior to intervention delivery in order to personalise intervention to individual strengths and weaknesses. Nevertheless, activities designed to heighten the child's awareness of their auditory environment are common components of most interventions and may be a key ingredient in effective interventions.

Children with speech and/or language disorders are often thought to have strengths in their visual, relative to their auditory, processing and for this reason their visual skills are used to compensate for their other difficulties. Within the child's most common contexts for learning, the classroom and the home environment, information is often presented visually ( NCLD 1999 ). In speech and language interventions, widespread use is made of pictorial support materials and visual timetables to help children make better use of auditory material. In some cases, interventions are supported by manual signing systems (for example, Makaton or Paget Gorman ).

Frequency, intensity and duration of interventions vary considerably. It may be that the amount of intervention is key to an intervention's success; however, variability between interventions and outcomes means it is difficult to make recommendations about optimal dosage ( Zeng 2012 ). It may be that for some outcomes that are measured continuously, such as vocabulary, there may be a simple dosage or response effect — the more intervention received, the greater the vocabulary learned — but for others, such as specific grammatical structures where outcomes are more focussed, intensity may be more functionally important than duration. Care has to be taken in adopting specific programmes to retain the recommended dosage, and to not assume that reducing the amount of intervention for pragmatic, cost‐related reasons is likely to lead to the same effects.

The outcome

On the one hand, the intervention is most likely to 'work' if the outcome directly reflects the intervention that the child receives. On the other, it is often considered more desirable and indeed more robust if effects can be demonstrated on standardised omnibus language tests. Consequently, an intervention may be said to work more effectively on very specific outcomes and may work less effectively on population, standard, norm‐referenced measures, which have commonly not been designed to capture change.

Adverse effects

There are no known adverse effects of the interventions concerned. It is important to acknowledge that there are potential implications in terms of raised anxiety in parents who are made aware that there is concern about their child's speech and/or language development. There could also be risks associated with children being taken out of their routine schooling (with resultant reduction in exposure to the curriculum) to attend specialist sessions if the sessions are found to be of uncertain benefit.

Why it is important to do this review

This protocol updates a previously published systematic review ( Law 2003a ), but is substantively different in that it excludes studies comparing interventions with alternative interventions — so called 'head‐to‐head' studies — so that this review will only report on treatments compared to no treatment or to a placebo. This has been done to aid interpretation of the results. An array of different alternative interventions, where there is rarely more than one version of any given alternative, make it difficult to report outcomes in a coherent fashion. Studies with alternative intervention comparison groups are often very different in terms of the treatment received. This increases heterogeneity and makes the combination of effect sizes problematic. Each alternative intervention comparison would need to be reported separately. It may be that in future iterations of this review, or in other reviews, specific head‐to head comparisons do become feasible.

There is a strong case for retaining the focus on interventions that include a broad range of language functions across childhood, to act as a benchmark in the field, although care needs to be taken to test for compatibility.

Previous reviews have largely been narrative in nature and thus prone to bias ( Goldstein 1991 ; Enderby 1996 ; Law 1997 ; McLean 1997 ; Gallagher 1998 ; Guralnick 1998 ; Olswang 1998 ; Yoder 2002 ; McCauley 2006 ; Leonard 2014 ). Two systematic reviews ( Nye 1987 ; Law 1998 ) were published prior to the publication of the first Cochrane review in the field ( Law 2003a ). A number have followed it, covering specific subpopulations or practice contexts; for example, interventions for preschool children only ( Schooling 2010 ), educational contexts ( Cirrin 2008 ), receptive language impairments ( Boyle 2010 ), parent‐child interaction ( Roberts 2011 ), grammatical development ( Ebbels 2013 ), computerised interventions ( Strong 2011 ), late talkers ( Cable 2010 ), language or literacy ( Reese 2010 ), and vocabulary learning in typically developing children ( Marulis 2010 ).

The original Cochrane review triggered a number of discussions about whether the approach employed in the review was the most effective, given the constraints associated with the subject domain and effectively captured in the Medical Research Council (MRC) guidelines ( Craig 2008 ). (See Pring 2004 ; Johnston 2005 ; Law 2005a ; Garrett 2006 ; Marshall 2011 ). While clinical guidelines to direct practice in speech and language therapy do exist ( RCSLT 2005 ; Johnson 2006 ), there remains little in the way of specific guidance on what type of intervention to offer children with primary speech and language impairment. This review has the potential to help inform such guidance where evidence is both sufficiently robust and sufficiently strong to warrant such recommendations.

Criteria for considering studies for this review

Types of studies.

We will include randomised controlled trials (RCTs).

Types of participants

Children and adolescents up to the age of 18 years who have been given a diagnosis of primary speech and/or language disorder by a speech and language therapist/pathologist, child development team or equivalent.

Exclusion criteria

We will exclude studies if there is clear evidence that children have learning disabilities, hearing loss, neuromuscular impairment or other primary conditions of which speech and/or language disorders are commonly a part. Children whose difficulties arise from stuttering or whose difficulties are described as learned misarticulations (for example, lateral /s/ (lisp) or labialised /r/ (rhotic r)) will also be excluded from this review. In addition, we will exclude studies that focus on bilingual or multilingual children as a feature of the study, and studies in which training of literacy skills is the primary focus of the study. We will also exclude from the review studies that include infants or babies.

Types of interventions

Any type of therapy intervention, of any duration and delivery method, compared with delayed ('wait‐list') or no‐treatment controls or general stimulation conditions. General stimulation conditions include, for example, studies where control children are assigned to a control condition designed to mimic the interaction found in therapy without providing the target linguistic input. These conditions may be cognitive therapy or general play sessions that do not focus on the area of interest in the study.

We will include therapy interventions designed to improve an area of speech and/or language functioning concerning either expressive and receptive phonology (production and understanding of speech sounds, including recognising and discriminating between speech sounds and awareness of speech sounds, for example, rhyming and alliteration), expressive or receptive vocabulary (production or understanding of words), expressive or receptive syntax (production or understanding of sentences and grammar), or pragmatic language.

Types of outcome measures

We will use formal standardised tests, criterion‐referenced tests, parent reports and language samples. Within each of these categories there are many different measures, and different measures assess different areas of speech and language. Some examples include the Clinical Evaluation of Language Fundamentals (CELF, Semel 1995 ), within which both language and phonology are measured, the New Reynell Developmental Language Scales (NRDLS, Edwards 2011 ) and the Children's Communication Checklist (CCC, Bishop 2003 ), which both measure language but not phonology, and the Diagnostic Evaluation of Articulation and Phonology (DEAP, Dodd 2006 ), which measures speech and phonology.

Intervention studies in this area commonly report more than one outcome (reflected in a range of different measures and measures that assess different areas of speech and language) and it may not always be explicit whether such outcomes are primary or secondary. In such cases we will make a judgement as to which of the outcomes are most closely linked to the goal of the intervention specified in the background to the study in question.

Outcomes used in the review must be matched to the participants' areas of difficulty (for example, we will not include receptive language outcomes in the review if one of the inclusion criteria for the study was that participants had to have receptive language within normal limits).

Primary outcomes

• Adverse effects. We will monitor studies for adverse effects. These are likely to be in the form of increased response of control relative to treatment groups, raised parental anxiety, and high dropout rates reflecting poor acceptability or parental dissatisfaction.

Secondary outcomes

• Composite language measures.
• Expressive vocabulary.
• Expressive syntax.
• Receptive vocabulary.
• Receptive syntax.
• Expressive phonology.
• Phonological awareness (including phonological recognition and discrimination).

We will use these primary and secondary outcomes to populate the 'Summary of findings' table.

Search methods for identification of studies

Electronic searches.

We will search the sources listed below for all available years. We will not limit our search by language, date of publication or publication status, and will seek translations where necessary.

• Cochrane Central Register of Controlled Trials (CENTRAL; current issue) in the Cochrane Library, and which includes the Cochrane Developmental, Psychosocial and Learning Problems Specialised Register.
• MEDLINE Ovid (1948 onwards).
• MEDLINE E‐pub ahead of print Ovid (current issue).
• MEDLINE In‐Process and Other Non‐Indexed Citations Ovid (current issue).
• Embase Ovid (1980 onwards).
• CINAHL EBSCOhost (Cumulative Index to Nursing and Allied Health Literature; 1937 onwards).
• ERIC EBSCOhost (Education Resources Information Center; 1966 onwards).
• PsycINFO Ovid (1872 onwards).
• LILACS (Latin American and Caribbean Health Sciences Literature; lilacs.bvsalud.org/en).
• SpeechBITE (speechbite.com).
• ProQuest Dissertations & Theses UK & Ireland (1950 onwards).
• Conference Proceedings Citation Index ‐ Science Web of Science (CPCI‐S; 1990 onwards).
• Conference Proceedings Citation Index ‐ Social Science & Humanities Web of Science (CPCI‐SS&H; 1990 onwards).
• Cochrane Database of Systematic Reviews (CDSR; current issue) in the Cochrane Library.
• Epistemonikos (epistemonikos.org).
• ClinicalTrials.gov (clinicaltrials.gov).
• World Health Organization International Clinical Trials Registry Platform (WHO ICTRP; who.int/trialsearch).

The search strategy for MEDLINE is in Appendix 1 . We will modify this search strategy, as appropriate, for all other databases and report these additional search strategies in an Appendix in the full review.

Searching other resources

We will check the reference lists of included studies and relevant reviews identified by the electronic searches for further studies. We will also contact key authors in the field for information about ongoing or unpublished studies that we may have missed. In addition, we will search The Communication Trust's What Works database of interventions (thecommunicationtrust.org.uk/whatworks).

Data collection and analysis

Selection of studies.

Review authors, working in pairs (JL, JAD and JJVC), will independently select potentially‐relevant studies for inclusion from the titles and citations or abstracts list generated by the search. Review authors will not be blinded to the name(s) of the trial author(s), institution(s) or publication source at any level of review.

Full‐text copies of all reports will be obtained and, if necessary, translated in order to assess eligibility. Two review authors (JL, JAD and JJVC, working in pairs) will independently assess reports against the inclusion criteria established under Criteria for considering studies for this review . When information is missing, we will contact trial investigators, where possible. Studies that have been identified by mutual consent will be included in the review.

Studies for which multiple reports appear will be categorised as 'included' or 'excluded' only once, and associated publications listed as secondary references. We will document all work in accordance within PRISMA guidance ( Moher 2009 ), and produce a flowchart of the process.

Data extraction and management

Two review authors (JL, JAD and JJVC) will independently extract data from reports of all eligible studies using a piloted form covering the following.

• Design and methods (including information necessary to complete 'Risk of bias' tables as per the Cochrane Handbook for Systematic Reviews of interventions ( Higgins 2011a )).
• Participants (including demographics/baseline characteristics such as age, gender, socioeconomic status and severity of speech and language difficulty).
• Interventions (setting, focus, method of delivery and duration).
• Outcome measures and associated outcome data, paying particular attention to modifications to scales, identity of assessor and timing of measurement.

We will resolve uncertainty and disagreement through discussion until consensus is reached. In addition, we may request further information from trial investigators, to ensure a given study meets inclusion criteria.

We will use endpoint scores (or 'post‐intervention', 'Time 2' or 'T2' scores) as our preferred treatment effect measure. When necessary, we will code multiple reports of a single study onto a single data extraction form. We will use a single Excel sheet to manage all numerical data from all forms.

Assessment of risk of bias in included studies

At least two review authors (JL, JAD and JJVC) will independently assess the risk of bias within each included study according to the Cochrane Handbook for Systematic Reviews of Interventions ( Higgins 2011a ). Review authors will independently assess the risk of bias within published reports of each included study across the seven domains described below and assign ratings of 'low', 'high' or 'unclear' risk of bias.

1. Sequence generation

We will determine whether studies used computer‐generated random numbers or a table of random numbers, drew lots or envelopes, or relied on coin tossing, shuffling cards, or throwing dice.

• Low risk of bias: the study authors explicitly stated that they used one of the above methods.
• High risk of bias: the authors did not use any of the above methods.
• Unclear risk of bias: there is no information on the randomisation method or it is not clearly presented.

2. Allocation concealment

We will evaluate whether investigators and participants could foresee assignments before screening was complete and consent was given.

• Low risk of bias: researchers and participants were unaware of future allocation to treatment conditions.
• High risk of bias: allocation was either not used or was not concealed from researchers before eligibility was determined, or was not concealed from participants before consent was given.
• Unclear risk of bias: information regarding allocation concealment is not known or not clearly presented.

3. Blinding of participants and personnel

Neither participants nor treatment providers (therapists) can be kept blind to the intervention condition in studies of this nature, and the resultant risk of bias will be recorded as ‘high: assessors were not blind to treatment condition’ for these component groups for this domain.

4. Blinding of outcome assessment

We will address the issue of whether or not outcomes were assessed by self‐report or whether objective assessors and coders of measures were employed and, if so, what steps were taken to blind them to treatment conditions.

• Low risk of bias: assessors were blind to the outcome assessment.
• High risk of bias: assessors were not blind to the outcome assessment.
• Unclear risk of bias: information on the blinding of assessors is unclear or unavailable from study authors.

5. Incomplete outcome data

We will identify the presence of incomplete outcome data as follows.

• Low risk of bias: there are no dropouts/exclusions; there are some missing data but the reasons for missing data are unlikely to be related to the true outcome; or missing data are balanced in proportion across intervention groups, with similar reasons for missing data across groups.
• High risk of bias: there is differential attrition across groups, reasons for dropout are different across groups, or there was inappropriate application of simple imputation (for example, assuming certain outcomes, last observation carried forward (LOCF), etc.).
• Unclear risk of bias: the attrition rate is unclear or authors state that intention‐to‐treat analysis was used but provide no details.

6. Selective outcome reporting

To assess reporting bias, we will attempt to collect all study reports and protocols and trial registration information, if possible, and will track the collection and reporting of outcome measures across all available reports for each included study.

• Low risk of bias: all outcome measures and follow‐ups are reported.
• High risk of bias: data from some outcome measures are not reported.
• Unclear risk of bias: it is not clear whether all data collected by study authors were reported.

7. Other sources of bias

Performance bias.

We will assess whether there were treatment differences between groups other than the main intervention.

• Low risk of bias: there were no treatment differences between groups other than the main intervention.
• High risk of bias: there were treatment differences between groups other than the main intervention.
• Unclear risk of bias: it is unclear whether there were differences between groups or this information was not available from study authors.

We will attempt to use the judgement of 'unclear risk of bias' as infrequently as possible.

Publication bias

We will make a concerted effort to identify unpublished RCTs in the field of interventions for speech and/or language disorders in order to establish whether there is publication bias.

Measures of treatment effect

We will use endpoint scores (or immediate 'post‐intervention', 'Time 2' or 'T2' scores) as our preferred treatment effect measure. These data may be binary or continuous.

Binary data

Although most of our prespecified outcomes are typically assessed with continuous measures, we anticipate some investigators may choose to dichotomise scale data into 'improved' or 'not improved'. In such cases, we plan to calculate odds ratios (ORs) with 95% confidence intervals (CIs).

Continuous data

When studies have used the same continuous outcome measure we will calculate mean differences (MDs) with 95% CIs. When studies have used different outcome measures to assess the same construct (for example, by using different scales to assess syntactic structure), we will calculate standardised mean differences (SMDs) and 95% CIs.

We will analyse and present conceptually‐distinct outcomes separately and will describe the properties of all scales used in a table, so that decisions concerning appropriate categorisation will be transparent to readers.

In the event that change scores are reported and endpoint data are not available, we will pool the data in Review Manager 5 ( RevMan 2014 ), using the MD (provided all instruments used for that outcome are the same), as recommended in the Cochrane Handbook for Systematic Reviews of Interventions (section 9.4.5.2, Deeks 2011 ). If outcome scales differ, we will present change score data separately, as combining data using SMD is unfeasible.

Unit of analysis issues

Cluster‐randomised studies.

Although it is likely that most of the interventions delivered for children with speech and language impairments will have randomised children at the individual level, there is a possibility that children will be allocated at a service level (clinic/school/class); so‐called cluster‐randomised studies. Cluster randomisation reduces the risk of contamination across those delivering the intervention. If we identify cluster‐RCTs, we will adhere to the guidance on statistical methods for managing data from cluster‐RCTs provided in the Cochrane Handbook for Systematic Reviews of Interventions (section 16.3, Higgins 2011b ). We will check that adequate adjustments for clustering were made for estimates of treatment effects. If not, we will seek to extract or calculate effect estimates and their standard errors as for a parallel‐group trial, and adjust the standard errors to account for the clustering ( Donner 1980 ). This requires information on an appropriate intraclass correlation coefficient (ICC); an estimate of the relative variability in outcome within and between clusters ( Donner 1980 ). If this information is not available in the relevant report, we will request it from the study authors. If this is not available or we receive no response, we will use external estimates obtained from studies that provide the best match on outcome measures and types of clusters from existing databases of ICCs ( Ukoumunne 1999 ), or other studies within the review. If we are unable to identify an appropriate ICC, we will perform sensitivity analyses using a high ICC of 0.10, a moderate ICC of 0.01 and a small ICC of 0.00 (see Sensitivity analysis ). These values are rather arbitrary but, as it is unlikely that the ICC is actually 0, it is preferable to use them to adjust the effect estimates and their standard errors. We will combine the estimates and corrected standard errors from cluster‐RCTs with those from parallel designs using the inverse variance method in RevMan 2014 .

Multiple treatment arms

We are aware that investigators frequently attempt to test many interventions or variations on similar interventions within the context of a single trial, even with a small sample. In such circumstances, where this is deemed appropriate by the review team, we may combine multiple eligible interventions tested within the same trial. This will be carried out using a standard formula for this purpose, as indicated in section 7.7.3.8 in the Cochrane Handbook for Systematic Reviews of Inverventions ( Higgins 2011c ). This formula for combining multiple arms is located in Table 7.7a within the Handbook, and can be used to combine numbers into a single sample size, mean and standard deviation for each intervention group. Where this has been carried out we will make it explicit in the review's narrative.

Cross‐over trials

With any educational or behavioural intervention such as speech and language therapy, true cross‐over trials are extremely unlikely. Should they arise, we are likely to treat them as parallel‐group studies and extract data at the point of first cross‐over. What is more common in this field are pseudo cross‐over studies of multicomponent interventions, in which one part of an intervention is delivered before the other in one intervention arm, and the second part delivered first in a second treatment arm (this resembles a cross‐over trial but is, in effect, a study of 'order of treatment' effect). As the review excludes head‐to‐head trials, we will only include pseudo cross‐over studies with a third 'no treatment', 'waiting control' or 'treatment‐as‐usual' arm. Therefore, we will extract endpoint data for both groups (after all parts of the multicomponent treatment are delivered).

Dealing with missing data

We will make every effort to contact the original investigators of included studies to gather information missing in the written reports.

For studies in which dropout is high or differently distributed between groups within the study, or both, we plan to conduct a Sensitivity analysis in which we will exclude such studies. We will not conduct any imputation of our own.

Assessment of heterogeneity

We anticipate clinical and methodological heterogeneity in included studies for a number of reasons. Different criteria are applied to children entering studies, sometimes making comparability across studies difficult. Similarly, different measures of speech and language are used to identify children for inclusion in studies and to measure outcomes. Finally, as indicated above, it is not uncommon for children identified with speech and/or language disorders to experience other 'comorbid' conditions such as other developmental difficulties or socioemotional problems. In some cases these are recorded; in others, it is unclear whether children experience such difficulties or not. These differences can make it challenging to compare across studies. To account for these differences, we will record assessment thresholds and potential comorbidity in our data extraction form and carry out subgroup analyses comparing groups of studies using the same or different assessments, more or less inclusive criteria, and with and without comorbidities.

We will explore heterogeneity by conducting subgroup analyses in RevMan 2014 . Characteristics of heterogeneity to be explored include the presence of more than one type of language impairment based on included outcomes in the current review (for example, expressive language impairment and phonological impairment), and the presence of an additional behaviour impairment (for example, attention deficit hyperactivity disorder, or behavioural, emotional and social difficulties).

We will assess statistical heterogeneity using the Chi² test for heterogeneity and a P value of 0.10 to account for low power due to small sample size. In addition, we will assess heterogeneity through visual inspection of forest plots (considering the magnitude of direction and effect) and the I² statistic ( Higgins 2003 ). We will consider values between 50% and 90% to represent substantial heterogeneity. As we will be using the random‐effects model we will also report tau² as a measure of between‐study variance. We will assess clinical and methodological heterogeneity by meta‐regression, using subgroups to explore how categorical study characteristics are associated with the intervention effects in the meta‐analysis.

See Subgroup analysis and investigation of heterogeneity .

Assessment of reporting biases

We plan to investigate the possibility of reporting biases, including publication bias, by assessing funnel plots for asymmetry where 10 or more studies report on the same outcome ( Egger 1997 ; Sterne 2001; Deeks 2005). Asymmetry could be due to publication bias or to a genuine relationship between trial size and effect size ( Sterne 2000 ). We will examine clinical variation of the studies to explore asymmetry.

We will diligently search for trial protocols for all included studies within the review; however, we are conscious that the trend to register protocols for trials has been less robust than in more traditionally 'medical' fields over time.

Data synthesis

We will only combine data where the intervention and the measurement are conceptually the same; primarily this will focus on the participant and intervention characteristics and study outcome. For example, all parent‐child interventions targeting and measuring expressive language may be combined. After this first pass, we will then make a judgement as to whether the interventions and measurements included in other studies are sufficiently similar to compare. We will base our decision to perform a quantitative synthesis of the data on whether the method of delivery (for example, parent, clinician) and outcome (for example, language, expressive vocabulary) of the intervention are the same constructs across studies. We will not combine data where interventions fall into different delivery or measurement categories.

Where appropriate, we will carry out data synthesis in RevMan 2014 , using inverse‐variance weighting. Differences in apparent intervention effects are considered as random effects (as it is less understood why such differences occur). If we are unable to conduct a meta‐analysis, we will carry out a narrative review of data.

Subgroup analysis and investigation of heterogeneity

We plan to conduct subgroup analyses to explore the impact of the study characteristics listed below on the results.

• intervention versus no intervention;
• parent versus no intervention;
• computer intervention versus no intervention; and
• peer intervention versus no intervention.
• intervention versus general stimulation;
• parent intervention versus general stimulation;
• computer intervention versus general stimulation; and
• peer intervention versus general stimulation.
• preschool children (birth to 4 years of age);
• primary school children (5 years to 11 years of age); and
• older children (12 years of age and above).
• comorbid disorders (e.g. behaviour disorders, autism spectrum disorders); and
• level of assessment (impairment cut‐off points).
• Variance in degree of heterogeneity. We plan to account for variance in degree of heterogeneity of language disorders by comparing studies in which more than one language impairment is present.

Sensitivity analysis

We plan to conduct sensitivity analyses to explore the effects on the results of including and excluding the types of studies below.

• Studies that do and do not have an explicit process for their randomisation.
• Studies where blinding of outcome assessors was inadequate or not attempted.
• Studies in which dropout is high (30%), or differently distributed between groups within the study, or both.

In addition, in cluster‐randomised studies where we are unable to identify an appropriate ICC, we will perform sensitivity analyses using a high ICC of 0.10, a moderate ICC of 0.01 and a small ICC of 0.00.

'Summary of findings' table

We will present a 'Summary of findings' table(s) within the completed review. We will use GRADEpro 2014 to prepare the 'Summary of findings' table(s), as needed. We plan to assess the overall quality of the evidence for each outcome as 'high', 'moderate', 'low' or 'very low' according to the GRADE approach (Schünemann 2011). We will consider the criteria below.

• Impact of risk of bias of individual trials.
• Precision of pooled estimate.
• Inconsistency or heterogeneity (clinical, methodological and statistical).
• Indirectness of evidence.
• Impact of selective reporting and publication bias on effect estimate.

We will use our primary and secondary outcomes ( Types of outcome measures ) to populate the 'Summary of findings' table(s).

Acknowledgements

The review authors wish to acknowledge Jo Abbott, Esther Coren, Julian Higgins, Stuart Logan, Georgia Salanti, and Geraldine Macdonald for support in previous versions of the review, and to thank investigators Maggie Vance, Ron Gillam, Laura Justice, Anne Hesketh, Yvonne Wren, Aoiffe Gallagher, Jim Boyle, Tim Pring, Susan Ebbels, Gwen Lancaster, Lucy Meyers, Gina Conti‐Ramsden, Rosana Clemente Estevan, Marc Fey, Sue Roulstone, Shari Robertson, Joe Reynolds, Jan Broomfield, Anne O'Hare, Charmian Evans, Marc Schmidt, Ralph Shelton, Louise Sutton, Janet Baxendale and Karla Washington for providing extra data and information. We are also grateful to Toby Lasserson of the Cochrane Editorial Unit (CEU) for his translation of articles in German.

Latterly, we wish to thank Joanne Wilson, Margaret Anderson and Gemma McLoughlin of Cochrane Developmental, Psychosocial and Learning Problems (CDPLP).

Appendix 1. MEDLINE search strategy

1 exp Communication Disorders/ 2 (speech adj5 disorder$).tw,kf. 3 (speech adj5 delay$).tw,kf. 4 (speech adj5 impair$).tw,kf. 5 (language adj5 disorder$).tw,kf. 6 (language adj5 delay$).tw,kf. 7 (language adj5 impair$).tw,kf. 8 dysglossia.tw,kf. 9 anomia.tw,kf. 10 Aphasia.tw,kf. 11 articulation.tw,kf. 12 echolia.tw,kf. 13 rhinolalia.tw,kf. 14 (mute or mutism).tw,kf. 15 "central auditory processing disorder".tw,kf. 16 "semantic‐pragmatic disorder".tw,kf. 17 or/1‐16 18 speech therapy/ 19 language therapy/ 20 myofunctional therapy/ 21 (speech adj5 (patholog$ or screen$ or therap$)).tw,kf. 22 speech train$.tw,kf. 23 (language adj5 (patholog$ or screen$ or therap$)).tw,kf. 24 language training.tw,kf. 25 ((grammar or grammatical) adj5 (facilitation or intervention$ or program$ or teach$ or therap$ or train$)).tw,kf. 26 ("Active Listening for Active Learning" or "Broad Target Recast" or "Core Vocabulary" or "Cycles Approach" or "Cycles for Phonology" or Earobics or "Electropalatography" or "Fast ForWord " or "Focussed Auditory Stimulation" or "Gillon Phonological Awareness Programme" or "Hanen" or "Let’s Learn Language" or "Lexicon Pirate" or "Lidcombe Programme" or "Linking Language" or "LINK‐S" or "Little Talkers" or "Makaton" or " Maximal Oppositions" or "Meaningful minimal contrast therapy " or "MMCT" or "Milieu Teaching" or "Milieu Therapy" or "Morpho‐syntactic" or "Multiple Opposition Therapy").tw,kf. 27 ("Naturalistic Speech Intelligibility Training " or "Non‐Linear Phonology Intervention " or "Non‐speech Oro‐motor Exercise " or "Nuffield Dyspraxia Programme " or "Nuffield Early Language Intervention " or "Oral Language Programme" or "Phoneme Factory " or "Phonology with Reading Programme " or "Picture Exchange System " or "Pre‐school Autism Communication Therapy " or PACT or "Psycholinguistic Framework " or "Rapid Syllable Transition Treatment" or "Shape Coding" or "Social Communication Intervention Programme" or "Social Stories" or "Strathclyde Language Intervention" or "Talk Boost" or "Talking Time" or "Thinking Together" or "Visualising and Verbalising").tw,kf. 28 or/18‐27 29 17 and 28 30 exp Speech Disorders/th,rh 31 exp Language Disorders/th,rh 32 Speech Therapy/mt 33 Language Therapy/mt 34 or/30‐33 35 29 or 34 36 exp Child/ 37 Infant/ 38 adolescent/ 39 (child$ or infant$ or baby or babies or toddler$ or boy$ or girl$ or pre‐school$ or preschool$ or kindergarten$ or kinder‐garten or teen$ or adolescen$ or schoolchild$ or schoolboy$ or schoolgirl or young people or youth$).tw. 40 or/36‐39 41 35 and 40 42 randomised controlled trial.pt. 43 controlled clinical trial.pt. 44 randomi#ed.ab. 45 placebo$.ab. 46 drug therapy.fs. 47 randomly.ab. 48 trial.ab. 49 groups.ab. 50 or/42‐49 51 exp animals/ not humans.sh. 52 50 not 51 53 41 and 52

Appendix 2. Data extraction form

Author and date of paper/publication/thesis:

Journal (or other source):

Which comparison?

• Speech and language therapy (SLT) versus nothing or wait‐list control (WLC); or
• SLT versus general stimulation.

Country (try to include state/province or city, or both, as well):

Setting (for example, school, clinic):

Number of participants at randomisation and at completion:

Unit of allocation:

Age at entry:

Study mix, for example, socioeconomic status (SES):

Gender mix:

Inclusion criteria (severity cutoff):

Intervention:

Target area of intervention:

Who delivers intervention?

How often? How long?

Comparator group (as above):

Length of follow‐up (note assessment points):

All outcomes measured (include scale information):

Outcomes used within this review / chosen for comparison:

• At the level of overall development, for example, phonological maturity or expressive language?
• At the level of disability, for example, improvement in intelligibility or consonant improvement in speech?

Results (use table below, state follow‐up point from which data are taken)

Expand / copy as necessary – do one per outcome, per time point

Name of outcome and measure:

Time point (for example, post‐treatment, six months, one year):

(* Be sure to think about intention‐to‐treat (ITT) when writing number (N) in: have trialists already adjusted results?) (** Check whether endpoint or change data have been used)

____________________________________________________ 'Risk of bias' judgements – provide quotation and page number, then judgement

Power calculation?

Items to correspond with trial investigators about?

Date contacted investigators:

Protocol first published: Issue 1, 2017

Contributions of authors

Professor James Law has overall responsibility for this review. All authors have contributed to the writing of this protocol.

Sources of support

Internal sources.

Office base and support for the review to be carried out during office hours

External sources

• No sources of support supplied

Declarations of interest

James Law (JL) ‐ is an author on one included study ( Law 1999 ) and one excluded study in the previous version of this review ( Kot 1995 ), and has published a non‐Cochrane review in this area ( Law 1997 ). For those studies in which JL is involved, the two other authors (JAD and JJVC) will assess the eligibility of studies for inclusion, complete 'Risk of bias' assessments and extract data. JL received £10,000 funding from the Nuffield Foundation for the previous version of this review ( Law 2003a ); the protocol of which was also published ( Law 2003b ). JL is an Editor for CDPLP. Jane A Dennis (JAD) — is the Feedback Editor for CDPLP. Jenna JV Charlton (JJVC) — none known.

This review is coregistered within the Campbell Collaboration ( Law 2005b ), as is the published protocol ( Law 2003c ).

This review supersedes the review by Law J, Garrett Z, Nye C. Speech and language therapy interventions for children with primary speech and language delay or disorder. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: {"type":"entrez-nucleotide","attrs":{"text":"CD004110","term_id":"30320848","term_text":"CD004110"}} CD004110 . DOI: 10.1002/14651858.CD004110 ( Law 2003a ).

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What Is Speech Therapy?

I f your child needs speech therapy, you're not alone. Here's everything you need to know about speech therapy for kids and toddlers.

If your child is currently in speech therapy or you're wondering if they might be a candidate for it, you're not alone. According to the American Speech-Language Hearing Association (ASHA), almost 8% of children in the United States have a communication or swallowing disorder. It doesn't mean you've done anything wrong, but it can be tough for families. The good news is speech therapy can make a difference.

So, what is speech therapy and how can it help? Here’s everything you need to know. 

How Does Speech Therapy Work?

Speech therapy is the treatment of communication, voice, and feeding/swallowing disorders by a trained professional.

Speech-language pathologists (SLPs) have a master's degree in speech-language pathology and specialize in evaluating, diagnosing, treating, and preventing these disorders. SLPs hold a license to practice in their state. 

You may also come across ASHA-certified SLPs. They have taken an additional step to pass a national exam and complete an ASHA-accredited supervised clinical fellowship.

Related: Everything You Need to Know About Language Development and Speech Delays in Children

What Does Speech Therapy Treat?

There are various reasons a child may need speech therapy. Common ones include:  

1. Speech sound disorders. This means a child has difficulty with the production of speech sounds and how we combine them into words.

2. Language disorders. A child will have difficulty understanding and/or using language to communicate. Language disorders may impact vocabulary development, grammar, as well as the ability to tell a story, follow directions, answer questions, and more.

3. Social communication disorder/pragmatic language disorder . In this case, a child will have difficulty using language to socialize. This may include difficulty understanding social cues, taking turns during conversation, initiating or maintaining a conversation, and understanding personal space. A social communication disorder often leads to difficulty forming friendships. Children with these language barriers may have a concurrent diagnosis of autism spectrum disorder .

4. Cognitive - communication disorder . This includes difficulty with memory, reasoning, problem solving, and organization, impacting the ability to communicate.

5. Voice disorder . Children will have differences in voice quality (e.g., being too hoarse or too nasal).

6. Fluency disorder/stuttering . Kids will have difficulty maintaining a smooth flow of speech. A fluency disorder may include repetitions of sounds within words, prolongations of parts of words, and/or pauses in speech.

7. Feeding/swallowing disorder . This presents as a difficulty with sucking, chewing, and/or swallowing food or liquid.

Signs a Child May Need Speech Therapy

Children may need speech therapy when they have not acquired speech/language milestones by an expected age. While milestones can vary from child to child, parents should refer their child for an evaluation if they have any concerns. Evaluation, which may include both standardized and non-standardized testing as well as observation, can help diagnose a speech/language disorder.

Some signs that may indicate a need for speech therapy include:

• A child isn't babbling by 6-7 months
• The child is having difficulty with feeding and/or swallowing
• A child beyond the age of 1 has no words
• A child beyond the age of 2 is not combining words into phrases
• The child's speech is difficult to understand
• The child is omitting syllables or sounds in words
• Speech errors are noticed during conversation
• The child has difficulty following directions or understanding spoken language
• The child has difficulty answering questions
• The child has a smaller vocabulary than what is expected for their age
• The child is stuttering
• The child's voice quality has changed or is noticeably hoarse or nasal
• The child has difficulty communicating with others socially
• The child has hearing loss
• The child has a cleft lip or palate

Related: Parenting a Child With a Speech Delay Can Be Lonely

What is Early Intervention Speech Therapy? 

Early intervention refers to state-funded evaluations and interventions—including speech therapy—for children, ages birth to 3, and their families. In some states, early intervention continues until the age of 5. While professionals may refer a child to early intervention, parents can also refer their child on their own.

Speech Therapy for Toddlers 

Speech therapy for toddlers usually resembles play where toys are used to elicit target skills, says Dominica Lumb, M.S., CCC-SLP, who has over 30 years of experience conducting speech therapy with children in various settings. 

Children are given choices during play to encourage the need to communicate. While working on language skills, toddlers are encouraged to request objects, ask questions, answer questions, and use appropriate vocabulary.

Parents may be included in therapy sessions at this age. They may be taught to model speech sounds or how to label objects and actions during everyday routines to enhance vocabulary development.

Speech therapy can also work differently depending on a child’s needs. For example, one may require a mode of communication that differs from speaking. That’s referred to as augmentative and alternative communication (AAC) and may include picture boards or computers/iPads for communicating through text or voice synthesizer. This can begin in early intervention and beyond.

Speech Therapy for Elementary-Aged Kids

Speech therapy at this stage is typically more structured. Games are often used for motivation, but goals are targeted through practice and repetition. Children practice new skills throughout a continuum until they're able to use these skills naturally in all environments.

After early intervention, children may continue receiving services in elementary school through an individualized education plan (IEP). The IEP is written by all specialists who will be working with the child. It states the child's goals and documents any accommodations the child may need to meet them.

Therapy at this age may follow a “pull-out” model where a child receives support in a separate classroom or a “push-in” model where an SLP provides services within the regular classroom. This model can change throughout the duration of therapy. For example, a child working on the correct production of a sound will typically begin with pull-out therapy and, when ready, will be observed in their classroom to assess for carryover of this skill.

SLPs in the school setting also consult with teachers to provide the support children need to communicate effectively in the classroom.

What About Private Speech Therapy?

While children must qualify for speech therapy through early intervention and in public schools, private practices can provide services beyond these standards.

Speech therapy in the private practice setting typically occurs one-on-one with the child receiving the SLP's undivided attention. But group therapy may occur when beneficial to the child.

"Therapy in the private practice setting is very child and family focused," explains Shanna Klump, M.S., CCC-SLP, CEO of Kid Connections Therapy in Severna Park, Maryland. "The family's goals for their child are often at the forefront of the work we do. In addition, parents and other family members often participate in the sessions to learn strategies that can be implemented at home to encourage generalization of skills."

What Age Is Best To Start Speech Therapy?

Parents should refer their child for a speech/language evaluation when they first notice their child is falling behind in any area of speech/language or is no longer meeting speech/language milestones . It is never too late or too early to start therapy but, in general, earlier intervention leads to a better outcome. If you're unsure if your child requires speech therapy, a referral to an SLP is always recommended.

Related: 7 Ways to Help Your Child's Language Development

How Parents Can Refer Their Child for Speech Therapy

A parent can contact their local early intervention office to learn about speech therapy options. The Centers for Disease Control and Prevention (CDC) provides early intervention contacts by state. Parents can also reach out to their child's health care provider to determine where their local early intervention office is located.

A school-aged child can be referred for a speech/language evaluation by reaching out to the child's teacher or the school's SLP.

An evaluation by a private SLP is an option at any age, but evaluations through early intervention or a public school district are provided at no cost. ASHA ProFind connects parents to SLPs who have indicated they are accepting referrals.

Does Insurance Cover Speech Therapy?

While public school therapy is free, private outpatient speech/language therapy is often covered by health plans, but with limitations.

According to Klump, insurance coverage for speech therapy varies by state, insurance plan, and diagnosis. She explains that while some states require habilitative service coverage for children, others do not.

Often, private practices, including Klump's Kid Connections, complete a benefits verification before initiating speech evaluation or therapy. In her experience, therapy sessions without insurance coverage may cost between $100-150, depending on location.

As each health plan has its own coverage, it is important to reach out to your insurance company to determine your out-of-pocket costs.

Insurance and Speech Therapy Coverage

If you're looking to see what insurance covers, Shanna Klump, M.S., CCC-SLP, CEO of Kid Connections Therapy, suggests parents obtain the following information from their insurance carrier:

• Visit limit. This may be a hard or soft limit which refers to whether an extension of services could be granted if deemed medically necessary
• Whether the visit limit is combined with other services. For example, occupational therapy and physical therapy are sometimes grouped with speech therapy in the number of sessions covered
• Whether there are exclusions to coverage for different diagnoses
• If a deductible must be met
• The co-pay amount per session

How Long Will My Child Be in Speech Therapy?

Speech therapy can take anywhere from months to years. Each child makes progress at their own rate and has individualized goals based on their communication needs. Just as children develop and meet milestones individually, the time it takes them to master new skills will vary.

How Effective Is Speech Therapy?

Speech therapy has been found to be effective for children. One study of more than 700 children with speech or language disorders up to 16 years old, found an average of six hours of speech therapy over six months significantly improved communication performance. Speech therapy was shown to be much more effective than no treatment over the same period.

Children of all ages typically find speech therapy engaging, fun, and rewarding. They're able to see their progress and use their newly learned skills proudly. Speech therapy is an effective way to enhance a child's ability to communicate and through these communication skills, a child will have better access to the world.

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• About the Parent Guides
• A Parent's Guide to Hearing Loss
• A Parent's Guide to Genetics and Hearing Loss

Early Interventions for Hearing Loss

What to know.

Interventions for hearing loss can vary for children depending on their age. Keep reading to find out more.

Interventions

No single treatment or intervention is the answer for every child or family. Good intervention plans will include close monitoring of the child and family needs, follow-ups to check progress, and making needed adjustments along the way to help support the child and family. There are many different options for children with hearing loss and their families. Some intervention options include the following:

• Working with a professional (or team) who can help a child and family learn to communicate.
• Getting a hearing device, such as a hearing aid.
• Joining support groups.
• Taking advantage of other resources available to children with a hearing loss and their families.

Early intervention (0-3 years)

Hearing loss can affect a child's ability to develop speech, language, and social skills. The earlier a child who is deaf or hard-of-hearing starts getting services, the more likely the child's speech, language, and social skills will reach their full potential.

Early intervention program services help young children with hearing loss learn language skills and other important skills. This intervention involves a therapist, such as a speech-language pathologist, teaching communication strategies to the child and parent(s) or helping the parent or other caregivers blend extra lessons into the day.

Babies who are diagnosed early with hearing loss should begin to get intervention services as soon as possible, ideally before 6 months of age.

There are many services available through the Individuals with Disabilities Education Improvement Act 2004 (IDEA 2004). Services for children from birth through 36 months of age are called Early Intervention or Part C services. Even if a child has not been diagnosed with a hearing loss, he or she may be eligible for early intervention treatment services. The IDEA 2004 says that children under the age of 3 years (36 months) who are at risk of having developmental delays may be eligible for services. These services are provided through an early intervention system in every jurisdiction. Through this system, parents can ask for an evaluation.

Special education (3-22 years)

Special education is instruction specifically designed to address the educational and related developmental needs of older children with disabilities or those who are experiencing developmental delays. Services for these children are provided through the public school system. These services are available through the Individuals with Disabilities Education Improvement Act 2004 (IDEA 2004), Part B.

Find additional information about interventions for hearing loss.

• National Center on Birth Defects and Developmental Disabilities
• Centers for Disease Control and Prevention

Parent Guides to Hearing Loss

If you are like most parents, after learning of your child’s hearing loss you will have mixed feelings and many questions.

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Early Intervention Therapist – Indianapolis, IN

Contact info:.

Katie Griffin 9192 Waldemar Rd. Indianapolis, IN 46268 317-471-8560 [email protected]

Job Title: Early Intervention Therapist Start Date: 8/1/24

Location: St. Joseph Institute for the Deaf

The Early Intervention Therapist provides individual listening and spoken language intervention to young children with hearing loss and their families. Additionally, this position provides support, counseling, and education to parents. These services are provided in the family home, in a limited remote capacity, or other appropriate setting. Families will be supported by the EI Therapist in their development of effective interactions to promote the development of spoken language skills in their young children with hearing loss. The EI Therapist will help children develop the ability to listen and talk through appropriate interactions with parents and others while engaged in play activities and daily routines. This position will assess early communication skills; responses of parents to a child’s attempt to communicate; child’s progress, needs and behaviors.

• The position is full-time, 218 contract days. Location: Hybrid – IN campus/Remote
• Starting salary is based on education and years of experience. Starting range is $57-$62K
• Master’s degree in Deaf Education, Speech Language Pathology, Audiology, or a related field required.
• Must hold Listening and Spoken Language Specialist Certification (AVT/AVEd) or be eligible for LSLS mentorship.
• Teacher certification by residing state or certification by the American Speech-Language-Hearing Association and hold a residential state License in Speech/Language Pathology or be eligible for same under the appropriate state law.
• Maintains credential requirements for First Steps.
• Minimum of two years of professional experience with children who are deaf or hard of hearing and should have experience in providing therapy to children with cochlear implants.
• Scope of experience may include both professional experience and experience obtained during clinical practicum.

How to Apply:

Send cover letter and resume to Katie Griffin, HR Manager, at [email protected] .

Recent Job Postings

Kamila Sukhov Explores The Benefits of Early Intervention in Speech Therapy for Children

Published by down beach author on may 17, 2024.

Speech and language development is a critical aspect of a child’s overall growth. It lays the foundation for communication, learning, and social interaction. Early intervention in speech therapy plays a pivotal role in addressing and mitigating speech and language disorders in children. Kamila Sukhov explains that by identifying and addressing these issues early, children are better equipped to develop essential communication skills, which significantly impact their academic performance, social relationships, and overall quality of life.

Understanding Speech and Language Disorders

Speech disorders refer to difficulties in producing sounds correctly, which can include articulation disorders (difficulty in making certain sounds), fluency disorders (such as stuttering), and voice disorders (problems with pitch, volume, or quality of voice). Language disorders, on the other hand, encompass difficulties in understanding and using spoken or written language. These can be expressive (difficulty in expressing thoughts) or receptive (difficulty in understanding language). Kamila Sukhov understands that these disorders can stem from various causes, including hearing impairments, developmental delays, neurological disorders, and genetic conditions. Early signs of speech and language issues may include limited vocabulary for the child’s age, difficulty following simple directions, trouble with pronunciation, and challenges in forming sentences.

The Importance of Early Intervention

• Enhanced Developmental Outcomes Early intervention is crucial because it capitalizes on the brain’s plasticity during the early years. The first few years of a child’s life are a period of rapid brain development. Speech therapy during this time can leverage this plasticity, making it easier to develop and improve communication skills. Children who receive early intervention often show significant improvements in speech, language, and cognitive development compared to those who start therapy later. • Prevention of Academic Challenges Speech and language skills are foundational for literacy and academic success. Children with untreated speech and language disorders are at a higher risk of experiencing difficulties in reading, writing, and other academic areas. Early intervention helps to mitigate these risks by providing children with the tools they need to develop effective communication skills, which are critical for learning and academic achievement. • Improved Social Skills Communication is a vital component of social interaction. Children with speech and language disorders may struggle with social skills, leading to feelings of frustration and social isolation. Early speech therapy can help children develop the ability to express themselves clearly and understand others, thereby enhancing their ability to form and maintain relationships. Improved social skills contribute to better emotional and psychological well-being. • Increased Confidence and Self-Esteem Speech and language disorders can significantly impact a child’s self-esteem. Difficulties in communication can lead to embarrassment, frustration, and a lack of confidence. Kamila Sukhov explains that through early intervention, children can develop effective communication skills, which boost their confidence and self-esteem. Being able to communicate successfully allows children to participate more fully in social and educational settings, fostering a positive self-image. • Parental Involvement and Support Early intervention programs often involve parents and caregivers, providing them with strategies and techniques to support their child’s development. Parental involvement is crucial as it reinforces the skills learned in therapy and provides a supportive environment for the child. Educating parents about speech and language development also helps them to identify potential issues early and seek appropriate intervention.

Key Components of Early Intervention

• Individualized Therapy Plans Each child’s speech and language needs are unique, and early intervention programs are tailored to meet these specific needs. Speech-language pathologists (SLPs) assess the child’s abilities and design individualized therapy plans that focus on the areas requiring improvement. These plans are flexible and can be adjusted as the child progresses. • Play-Based Therapy For young children, therapy often incorporates play-based activities. Play is a natural and engaging way for children to learn and practice new skills. Through games, stories, and interactive activities, children can develop their speech and language skills in a fun and supportive environment. • Use of Technology Advancements in technology have provided new tools for speech therapy. Interactive apps, online games, and other digital resources can supplement traditional therapy methods. Kamila Sukhov understands that these tools can make therapy more engaging and accessible, especially for children who may benefit from additional practice at home. • Multidisciplinary Approach Early intervention often involves a multidisciplinary team, including SLPs, pediatricians, psychologists, and educators. This collaborative approach ensures that all aspects of the child’s development are addressed. Working together, these professionals can provide comprehensive care and support tailored to the child’s needs.

Early intervention in speech therapy is a proactive approach that can significantly improve the outcomes for children with speech and language disorders. Kamila Sukhov emphasizes that by addressing these issues early, children are better prepared to succeed academically, socially, and emotionally. The benefits of early intervention extend beyond speech and language development, contributing to the overall well-being and future success of the child. Parents and caregivers play a crucial role in this process, and their involvement and support are essential for the child’s progress. As awareness of the importance of early intervention grows, more children can receive the help they need to thrive.

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Am Fam Physician. 2024;109(5):482-483

Author disclosure: No relevant financial relationships.

Key Points for Practice

• Early intervention, family therapy, and supported employment services are important elements of care for first-episode psychosis.

• Schizophrenia is best managed in assertive community care models and can include aerobic activity, yoga, psychotherapy, and supported housing in addition to medication.

• Second-generation antipsychotic medications are the recommended medical therapy. Adverse effects vary, and changing medications can improve tolerability. 

• Clozapine is more effective for positive symptoms but should be reserved for treatment-resistant psychosis due to serious adverse effects, including agranulocytosis.

From the AFP Editors

First-episode psychosis commonly presents in males in their early to mid-20s and females in their late 20s and is often triggered by stress. First-episode psychosis can appear as a prodrome to schizophrenia, and management can improve the severity of psychiatric illness later in life. Schizophrenia is a neurodevelopmental disorder that impacts approximately 1% of the U.S. population. Schizophrenia presents with positive symptoms including perceptual distortions, such as hallucinations and delusions, and motor deficits and negative symptoms including diminished emotional expression and significant reduction in goal-directed activities. Negative symptoms are the most important predictor of poor long-term functioning. People with schizophrenia die an average of 15 years earlier than unaffected individuals. The U.S. Department of Veterans Affairs and U.S. Department of Defense (VA/DoD) published new recommendations for diagnosing and managing schizophrenia and first-episode psychosis.

Screening for Psychosis

There are numerous screening and assessment instruments for predicting if a patient with suspected psychosis will transition to psychosis; however, they have low specificity and are recommended only for use in a specialty mental health care environment. There is insufficient evidence to recommend using biomarker screening tools. Although magnetic resonance imaging appears reasonably accurate in small studies of high-risk patients, standardized criteria are not yet available.

Management of First-Episode Psychosis

Patients with a first episode of psychosis should receive early intervention services. Early interventions include 32 evidence-based components, including family interventions and supported employment. Family interventions improve symptoms and functionality and reduce hospitalization length and future relapses compared with individual care. Individual placement and supported employment should be considered, with the goal of participation in employment or education. Use of an antipsychotic other than clozapine for initial treatment based on patient characteristics and adverse effect profiles is recommended. About five patients need to be treated with an antipsychotic for one additional response vs. placebo.

Treatment with early intervention services for 2 years improves the severity of positive and negative symptoms more than usual treatment. Although early intervention services can be extended up to 5 years, there is little evidence to support this prolonged treatment. Nearly two-thirds of people with significant psychiatric illness desire employment, but only 15% are employed. Supported employment programs for people with first-episode psychosis increase employment at 6 months or longer vs. usual treatment.

For patients with comorbid substance use disorders, family therapy reduces the severity of substance use.

Management of Schizophrenia

Treatment should be provided through assertive community care models, which include shared caseload among teams with low patient-to-staff ratios, high frequency of patient contact, direct service provision, and community outreach. This treatment can reduce hospitalizations and rates of relapse. Aerobic exercise can be considered in addition to usual treatment to reduce negative symptoms and improve functioning, and yoga may reduce positive and negative symptoms.

Adding cognitive behavior therapy to medication can improve outcomes, especially in prodromal and early psychosis. Acceptance and mindfulness-based therapy, meta-cognitive therapy, and positive psychology interventions can also be considered. Cognitive remediation training can reduce positive symptoms and improve concentration, memory, and problem solving. Social skills training can be considered, although evidence of benefit is conflicting.

Supported housing improves housing stability but not hospital admissions or medication adherence and has insufficient evidence to be recommended. Weekly telephone-based care management can reduce rehospitalizations and should be considered.

Pharmacologic Treatment of Schizophrenia

Maintenance treatment with antipsychotic medications prevents relapse (NNT = 3) and hospitalization (NNT = 10) compared with placebo. Because second-generation anti-psychotics have similar improvement and different adverse effects, a trial of a different medication is recommended if the patient has intolerance or inadequate response to one medication. Long-acting injectable antipsychotics can improve medication adherence and may be considered.

Because of increased risk of serious adverse effects, clozapine should be reserved for patients with treatment-resistant psychosis, defined as an unsuccessful 6-week trial of at least two medications at effective doses. Clozapine has greater improvement in positive symptoms than other antipsychotics. The U.S. Food and Drug Administration requires a risk evaluation and mitigation strategy to ensure that patients who use clozapine are registered and blood testing requirements are met because of the risk of agranulocytosis. If there is an inadequate response to clozapine alone, adding another second-generation antipsychotic may be considered.

Treating Adverse Effects of Antipsychotics

Metformin, topiramate, and aripiprazole can be considered to improve the metabolic adverse effects of antipsychotics, including weight gain. Although some studies suggest that aripiprazole can improve hyperprolactinemia, the benefits appear limited to laboratory values without an improvement in symptoms, and the guidelines do not recommend for or against its use.

The guidelines suggest considering treatment of tardive dyskinesia with vesicular monoamine transporter 2 inhibitors, including deutetrabenazine (Austedo), tetrabenazine (Xenazine), and valbenazine (Ingrezza), which may reduce symptoms, including involuntary movements.

Clozapine can cause sialorrhea, or excessive salivation, which is best treated with diphenhydramine.

Editor's Note: This evidence-based review of care for patients with schizophrenia is the first I have seen. With the current mental health professional shortage, I welcome this review to update my understanding of schizophrenia and first-episode psychosis and how care differs between the two.—Michael J. Arnold, MD, Assistant Medical Editor

The numbers needed to treat reported in this Practice Guideline were calculated by the author based on raw data provided in the original guideline.

The views expressed are those of the author and do not reflect the official policy or position of the Naval Undersea Medical Institute, U.S. Navy, U.S. Department of Defense, or U.S. government.

Guideline source: U.S. Department of Veterans Affairs and U.S. Department of Defense

Published source: VA/DoD clinical practice guideline for management of first-episode psychosis and schizophrenia; April 2023.

Available at:  https://www.healthquality.va.gov/guidelines/MH/scz/index.asp

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide .

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